A content analysis of an online pro-eating disorder community on Reddit

The romanticisation of mental health problems in adolescents and its implications: a narrative review

Romanticisation is the perception and portrayal of a phenomenon as more attractive, interesting, cool, profound or desirable than it really is. There are concerns that mental health problems are increasingly romanticised, particularly among adolescents, but there is limited research on this topic. This narrative review investigated: (1) what romanticisation is in the context of adolescent mental health problems, (2) why adolescents might romanticise mental health problems, (3) the implications of romanticising mental health problems in adolescence, and (4) what interventions might reduce this phenomenon. Sixty-one publications were reviewed, including qualitative and quantitative analyses, cross-sectional and longitudinal self-report studies and conceptual reviews. Most investigated romanticisation of mental health problems online, with most researchers situated in a Western context. Identity formation, popular media influences and peer influences arose as potential explanatory factors. Negative outcomes to romanticisation were indicated, including the reinforcement of mental health problems and reduced help-seeking; few interventions to reduce the phenomenon have been proposed to date.

Autistic Burnout on Reddit: A Sisyphean Struggle with Daily Tasks

The crippling impacts of autistic burnout are well known to the autistic community, yet research is only in its early stages. While research to date has chiefly relied on structured interviews and Delphi studies, it has focused on defining and measuring burnout. What is missing from the research is an analysis of the broader experiences of autistic burnout, and the very real implications that autistic people face when impacted by it. This study reviewed the narratives of autistic people discussing their experiences of autistic burnout on the social media platform Reddit. Using data scraped from Reddit, quantitative and qualitative analyses were undertaken to elicit meaning from the online discourse. After analysing 249 Reddit threads using quantitative content analysis, the results supported existing research identifying three core components of autistic burnout, those being: chronic exhaustion; increased sensory sensitivities; and social withdrawal. New insights were found with users reporting physiological ailments as a complicating factor in their burnout experience. The research also found evidence supporting suggested treatment options for autistic burnout including reducing/stopping social obligations, reducing sensory inputs as much as possible, and time spent alone to reset and recharge. Most importantly, users identified that being autonomous in their recovery choices was critical to the success of their recovery.

Abortion access barriers shared in "r/abortion" after Roe: a qualitative analysis of a Reddit community post-Dobbs decision leak in 2022

With drastic changes to abortion policy, the months following the Dobbs leak and subsequent decision in 2022 were a uniquely uncertain and difficult time for abortion access in the United States. To understand experiences of challenges to abortion access during that time, we used a hybrid inductive and deductive thematic coding approach to analyse descriptions of barriers and their impacts shared in an abortion subreddit (r/abortion). A simple random sample of 10% of posts was obtained from those shared from 02 May 2022 through 23 December 2022; comments were purposively sampled during the coding process. In this sample of submissions (n = 523 posts, 88 comments), people described structural barriers identified in past research, including state abortion bans and gestational limits, high costs, limited appointment availability, and long travel required. Posters also commonly described known social barriers, including limited social support and abortion stigma. Several impactful barriers not well-described in past research emerged inductively, including wait time for receiving mail-ordered abortion medication, low credibility of online ordering platforms, and concerns about legal risks of accessing abortion or related medical care. The most common consequences of experiencing barriers were adverse mental health outcomes, delayed access to care, and being compelled to self-manage their abortion because of access barriers. This analysis provides timely insights into the experiences and impacts of abortion access barriers in a group of people with a range of engagement with clinical abortion care, lived experiences, and points in their abortion processes, with public health implications for mental health and abortion access.

Exploring nutrition-related interests of the transgender and gender-diverse community: a content analysis of a transgender-centric discussion forum on Reddit

OBJECTIVE

The solicitation of nutrition-related health advice on social media platforms is on the rise. However, there is a paucity of research on the distinctive nutrition-related concerns and needs faced by transgender and gender-diverse individuals. Understanding patterns of nutrition-related information-seeking behaviour is vital to advancing health promotion efforts within this community. This study aimed to characterise the nutrition-related questions posed by the transgender community on a prominent social media outlet, Reddit.

DESIGN

A qualitative, cross-sectional content analysis was conducted, focusing on the top 100 submissions (ranked by popularity) within a transgender-centric online subreddit (r/asktransgender). Data extraction was facilitated using the Application Programming Interface Pushshift. The content analysis was conducted using NVivo.

SETTING

The study was situated within the discussion forum of the social media platform, Reddit.

RESULTS

A total of 148 references from 90 eligible posts were identified and coded. The major themes included the effects of hormone replacement therapy (HRT) on nutritional health (n 66), weight status (n 45), dietary needs and behaviours (n 21), physical activity and weight loss on body shape (n 9), social undermining (n 4) and effects of health behaviours on HRT (n 3).

CONCLUSION

This study underscores the pressing need for tailored and evidence-based nutrition guidelines and communication toolkits that specifically address the distinct needs and experiences of transgender individuals, particularly those undergoing HRT.

Why am I obsessed with viewing mukbang ASMR? The roles of mediated voyeurism and intertemporal choice

This study investigates the determinants of the obsessive view of mukbang autonomous sensory meridian response (Mukbang ASMR) and examines the moderation role of intertemporal choice and the mediating effect of mediated voyeurism among university students in Malaysia. A quantitative survey was conducted with 408 university students in Malaysia who viewed mukbang channel(s) often on social media. PLS-SEM is adopted to examine the associated paths and effects. The results demonstrate the significant impact of alienation and novelty, vicarious satisfaction, companionship and loneliness on mukbang ASMR obsession. Mediated voyeurism intervenes the effects of alienation and novelty on mukbang ASMR and intertemporal choice positively moderates the relationship between companionship and loneliness and mukbang ASMR. This study constructs a model to estimate Mukbang ASMR obsession by identifying specific motives and relationships among key factors, highlighting loneliness as the most effective determinant of mukbang ASMR among Malaysian younger generation. Research results provide an extended understanding of the mukbang ASMR, offering valuable insights in the areas of lifestyle, social well-being, and social media consumption.

"I don't wanna die, but my brain insists that I should": a big qualitative data approach to the lived experiences of suicidal thoughts

Introduction

There remains a dearth of knowledge concerning the phenomenology of suicidal thoughts, with research focusing on reasons for feeling suicidal rather than their mental expression. While clinical interviews remain the standard phenomenological approach, such exploration of lived experiences may prove challenging for this sensitive topic. As a complementary alternative, the use of naturally-occurring online data is opportune for capturing elaborations on tabooed phenomena.

Methods

In this phenomenological study, we present a thematic analysis on lived experiences of suicidal thoughts as spontaneously reported by non-identified users of a Reddit online board (r/Depression), collecting 668 posts using the search terms "suicidal ideation," "suicidal thoughts," and "suicide." Codes were grouped into descriptive categories summarizing the properties of thoughts, their effects, and their relation to suicide. Then, an interpretative synthesis yielded global themes connecting salient meanings on the experience of suicidal thoughts.

Results

With a long-term and recurring nature, thoughts of suicide appear in the form of vivid imagery and daydreaming's, initially bringing relief to adverse feelings but eventually becoming conditioned and all-consuming. Rather than a wonderment, they are experienced as intrusive thoughts by people struggling to make meaning of their occurrence. When conciliating the presence of unwanted thoughts, users express intricate relations to wishing or not to die, as well as varying perceptions of control over actions or fear of suicidal behavior.

Discussion

With an innovative application of big qualitative data into phenomenological analysis, this study contributes to an initial characterization of suicidal thoughts, uncovering findings that are not contemplated into current conceptualizations of suicidality. The analysis is limited by a restricted context of posts and unknown demographics, and further research with clinical interviews is warranted for in-depth exploration of suicidal thoughts.

Empathy and redemption: Exploring the narrative transformation of online support for mental health across communities before and after Covid-19

This study examines the impact of the COVID-19 pandemic on individuals' mental health and their online interactions, particularly within Reddit's mental health communities. By analyzing data from 15 subreddits categorized into mental health and control groups from 2018 to 2022, we observed that forums dedicated to mental health exhibited higher levels of user engagement and received more supportive responses than those in other categories. However, as the pandemic evolved, a significant decrease in online support was noted, especially within these mental health groups. This decline hints at a risk of emotional burnout among users, which poses a particularly acute challenge for individuals grappling with mental health issues. Intimate relationships have also an impact on online expression of mental health. The research underscores the pandemic's effect on online support and interaction dynamics, signaling the necessity for a deeper understanding and the development of strategies to maintain support within online communities during times of crisis.

Does generative artificial intelligence pose a risk to performance validity test security?

OBJECTIVE

We examined the performance validity test (PVT) security risk presented by artificial intelligence (AI) chatbots asking questions about neuropsychological evaluation and PVTs on two popular generative AI sites.

METHOD

In 2023 and 2024, multiple questions were posed to ChatGPT-3 and Bard (now Gemini). One set started generally and refined follow-up questions based on AI responses. A second set asked how to feign, fake, or cheat. Responses were aggregated and independently rated for inaccuracy and threat. Responses not identified as inaccurate were assigned a four-level threat rating (no, mild, moderate, or high threat). Combined inaccuracy and threat ratings were examined cross-sectionally and longitudinally.

RESULTS

Combined inaccuracy rating percentages were 35 to 42% in 2023 and 16 to 28% in 2024. Combined moderate/high threat ratings were observed in 24 to 41% of responses in 2023 and in 17 to 31% of responses in 2024. More ChatGPT-3 responses were rated moderate or high threat compared to Bard/Gemini responses. Over time, ChatGPT-3 responses became more accurate with a similar threat level, but Bard/Gemini responses did not change in accuracy or threat. Responses to how to feign queries demonstrated ethical opposition to feigning. Responses to similar queries in 2024 showed even stronger ethical opposition.

CONCLUSIONS

AI chatbots are a threat to PVT test security. A proportion of responses were rated as moderate or high threat. Although ethical opposition to feigning guidance increased over time, the natural language interface and the volume of AI chatbot responses represent a potentially greater threat than traditional search engines.

Examining Symptoms of Stimulant Misuse and Community Support Among Members of a Recovery-Oriented Online Community

Misuse of prescription and non-prescription stimulants and related overdose deaths represent a growing public health crisis that warrants immediate intervention. We examined 100 posts and their respective comments from a public, recovery-oriented Reddit community in January 2021 to explore content related to DSM-V stimulant use disorder symptoms, access and barriers to recovery, and peer support. Using inductive and deductive methods, a codebook was developed with the following primary themes: 1) DSM-V Symptoms and Risk Factors, 2) Stigma/Shame, 3) Seeking Advice or Information, 4) Supportive or Unsupportive Comments. In 37% of posts community members reported taking high doses and engaging in prolonged misuse of stimulants. Nearly half of posts in the sample (46%) were seeking advice for recovery, but 42% noted fear of withdrawal symptoms or a loss of productivity (18%) as barriers to abstinence or a reduction in use. Concerns related to stigma, shame, hiding use from others (30%), and comorbid mental health conditions (34%) were also noted. Social media content analysis allows for insight into information about lived experiences of individuals struggling with substance use disorders. Future online interventions should address recovery barriers related to stigma and shame as well as fears associated with the physical and psychological impact of quitting stimulant misuse.

Waiting to start abortion: A qualitative exploration of narratives of waiting shared in a Reddit community for abortion post-Dobbs leak in 2022

With the Dobbs leak introducing uncertainty about access and the Dobbs v. Jackson Women's Health Organization decision in June of 2022 overturning the US constitutional right to abortion, delays in accessing desired abortion care are likely growing longer and more common. Timely research on people's experiences waiting to access abortion care is needed. Using data from an abortion subreddit (r/abortion), we analyzed posts that described waiting after having decided to terminate the pregnancy, either by having an in-clinic appointment or ordering medication(s) online for self-managed abortion. Our analysis explored described 1) wait time length, 2) factors contributing to waiting, and 3) impacts of waiting. We used a hybrid inductive and deductive thematic qualitative coding approach to analyze a month-stratified 10% random sample of posts to the r/abortion community in 2022 surrounding the Dobbs leak and decision (May-December, n = 523 posts). Among posts to r/abortion that described waiting to start an abortion (n = 80), wait times ranged from one day to more than a month. Lack of appointment availability and waiting for mailed medications were commonly described as causing delays in accessing in-clinic abortion care and self-managed abortion, respectively. People shared challenges with pregnancy symptoms and feelings of anxiety, fear, isolation, and uncertainty. Posters also commonly described needing additional support while waiting. Overall, waiting to start an abortion was extremely stressful and isolating., with people often waiting weeks between ordering medication or scheduling an appointment and initiating the abortion process. Experiences of waiting to start an abortion and their impacts are of increasing concern as abortion access is further restricted. Additional targeted information and support are needed to mitigate these challenges. Providing timely access is imperative to quality care and overall abortion experiences.

Autistic Women's Experience of Motherhood: A Qualitative Analysis of Reddit

Autistic mothers remain under-represented in parental and autism research despite the associated physical and psychosocial challenges that accompany the transition to motherhood. Extant literature suggests autistic mothers experience sensory difficulties, communication challenges, stigma, and comorbidities as difficulties, but these studies have focused on autistic women in the perinatal period. The aim of this study was to examine reflections on motherhood from a Reddit community for autistic parents. Identified themes were Autistic Mothering is Different, Autistic Mothers Need Autistic Mothers, Autistic Mothers Experience Stigma, and Learnings from Lockdown. Findings extend existing research by offering insight into the ways autism impacts mothers beyond the perinatal period and have important implications for the future design and delivery of support services for autistic mothers.

Digging into digital buffets: A systematic review of eating-related social media content and its relationship with body image and eating behaviours

Recently, researchers have started investigating the influence of eating-focused social media content on viewers' body image and eating behaviour. The current systematic review collates the evidence for the relationship between exposure to eating-related social media content and people's body image, disordered eating, food consumption, and eating-related opinions. Following PRISMA guidelines, searches were conducted on five databases (i.e., Medline, PsycINFO, Web of Science, Scopus, and ProQuest), resulting in 38 eligible studies that examined the link between eating-related content and body image, eating behaviour and/or viewers' perceptions. Evidence showed positive relationships between exposure to certain material on social media (e.g., fast-food advertisements, clean eating, eating videos) and body image concerns, disordered eating, and consumption of, or a willingness to consume the foods seen on social media; however, studies that focused on 'healthy food' content showed no such link. Viewers expressed mixed feelings towards content such as nutrition information and mukbang videos which record hosts eating a large amount of food. Future research would benefit from a consistent measure of exposure to different eating-related content. There is also a need for more experimental research to examine the impact of watching different types of eating videos on body image, disordered eating, and food consumption.

Public Attitudes Towards Vaccine Passports in Alberta During the "Pandemic of the Unvaccinated": A Qualitative Analysis of Reddit Posts

Objective: The goal of this study is to understand the attitudes and beliefs towards mandatory vaccination policies in Alberta, Canada in September 2021, during the fourth wave of COVID-19. Methods: 9400 posts between 1st September and 30th September 2021 were collected from the subreddit r/Alberta with Pushshift.io. Posts and comments were manually screened to determine their relevance to research objectives, and then coded using inductive coding and iterative qualitative analysis methods. Results: Inductive coding methods yielded five key themes: 1) opinions related to autonomy and consent, 2) concerns about COVID-19 vaccine passport enforcement, 3) concerns about government, 4) concerns about the logistics of passports, and 5) opinions relating to the necessity of passports to prevent lockdowns. Conclusion: Overall, the data presented favorable opinions towards an Albertan vaccine passport within r/Alberta. Anti-vaccine and anti-mandate opinions were often less extreme than those present in the literature, although this may be due to r/Alberta subreddit moderators removing those more extreme comments. Most reservations were due to issues of bodily autonomy, though concerns about the government and logistics also played a meaningful role.

Applying Stages of Change Model to Examine Online Peer Communication on Binge Eating

Despite the distress and disruption associated with eating disorder (ED), people struggling with EDs are often ambivalent about their eating issues and unmotivated for recovery. Rather than seek professional help, these people tend to turn to online ED groups for information and support. Using the stages of change model, this study investigates the characteristics of online peer communication around binging vis-à-vis participants' motivation and readiness for behavioral change. Our results illustrate how individuals with binging issues in different motivational stages discuss their problematic eating online and provides insights into their ambivalence toward treatment and relapses into binging. This study further clarifies how people with binging issues feel trapped in a cycle of dieting-binging, which is observed to be undergirded by unresolved weight-related issues, and how they cope with the stressful relationship between eating and body weight through their postings on social media. These findings suggest that healthcare providers should promote healthier methods of addressing the weight gain from binge eating and provide support tailored to individuals' motivational stage in breaking the dieting-binging cycle.

Leveraging the Black Girls Run Web-Based Community as a Supportive Community for Physical Activity Engagement: Mixed Methods Study

BACKGROUND

About 59%-73% of Black women do not meet the recommended targets for physical activity (PA). PA is a key modifiable lifestyle factor that can help mitigate risk for chronic diseases such as obesity, diabetes, and hypertension that disproportionately affect Black women. Web-based communities focused on PA have been emerging in recent years as web-based gathering spaces to provide support for PA in specific populations. One example is Black Girls Run (BGR), which is devoted to promoting PA in Black women.

OBJECTIVE

The purpose of this study was to describe the content shared on the BGR public Facebook page to provide insight into how web-based communities engage Black women in PA and inform the development of web-based PA interventions for Black women.

METHODS

Using Facebook Crowdtangle, we collected posts (n=397) and associated engagement data from the BGR public Facebook page for the 6-month period between June 1, 2021, and December 31, 2021. We pooled data in Dedoose to analyze the qualitative data and conducted a content analysis of qualitative data. We quantified types of posts, post engagement, and compared post types on engagement: "like," "love," "haha," "wow," "care," "sad," "angry," "comments," and "shares."

RESULTS

The content analysis revealed 8 categories of posts: shout-outs to members for achievements (n=122, 31%), goals or motivational (n=65, 16%), announcements (n=63, 16%), sponsored or ads (n=54, 14%), health related (n=47, 11%), the lived Black experience (n=23, 6%), self-care (n=15, 4%), and holidays or greetings (n=8, 2%). The 397 posts attracted a total of 55,354 engagements (reactions, comments, and shares). Associations between the number of engagement and post categories were analyzed using generalized linear models. Shout-out posts (n=22,268) elicited the highest average of total user engagement of 181.7 (SD 116.7), followed by goals or motivational posts (n=11,490) with an average total engagement of 160.1 (SD 125.2) and announcements (n=7962) having an average total engagement of 129.9 (SD 170.7). Significant statistical differences were found among the total engagement of posts (χ72=80.99, P<.001), "like" (χ72=119.37, P<.001), "love" (χ72=63.995, P<.001), "wow" (χ72=23.73, P<.001), "care" (χ72=35.06, P<.001), "comments" (χ72=80.55, P<.001), and "shares" (χ72=71.28, P<.001).

CONCLUSIONS

The majority of content on the BGR Facebook page (n=250, 63%) was focused on celebrating member achievements, motivating members to get active, and announcing and promoting active events. These types of posts attracted 75% of total post engagement. BGR appears to be a rich web-based community that offers social support for PA as well as culturally relevant health and social justice content. Web-based communities may be uniquely positioned to engage minoritized populations in health behavior. Further research should explore how and if web-based communities such as BGR can be interwoven into health interventions and health promotion.

Assessing Arabic youtube videos on herbal cancer treatment: Absence of health information quality

This study assesses the quality of the health information in Arabic YouTube videos regarding herbal cancer treatment. It also provides an overview of how the quality of video content shapes user awareness by assessing the users' engagement indicators. A simple Python tool was developed using YouTube API V3 to automate the YouTube search based on the recommendation of Google Trends. After applying inclusion and exclusion criteria, 110 YouTube videos were selected, of which 95% were uploaded by non-experts and had a total of 8,633,569 views. The analyzed videos presented more than 40 different herbals as sources of cancer treatment; for example, Ephedra, garden cress, Green tea, Ginseng, Rosemary, and Thyme. 32.7% of the videos provided information about a single herb, 41% about mixing herbals, and 26.3% provided testimonials and success stories without pointing to specific herbs. The videos were assessed by two experts using two reliable tools, DISCERN and PEMAT, which were produced mainly for assessing health information quality. DISCERN has evaluated the reliability and quality of health information. PEMAT has assessed the understandability and actionability. The qualitative and quantitative analyses of the videos represent bias and poor health information quality, with a total score of 27 out of 80 for DISCERN and 31 out of 100 for the PEMAT. The results also showed weak users' awareness regarding the content of videos with no association between user engagement indicators (likes, dislikes, VPI, views, comments) and the dimensions of the two tools. The study concludes that it is evident that YouTube, in its current form, is an inadequate Arabic source for herbal cancer treatment information. To overcome this, this study proposed the GAP framework for social media that integrated Governance, Awareness, and Proficiency.

Exploring Language Used in Posts on r/birthcontrol: Case Study Using Data From Reddit Posts and Natural Language Processing to Advance Contraception Research

BACKGROUND

Contraceptive choice is central to reproductive autonomy. The internet, including social networking sites like Reddit, is an important resource for people seeking contraceptive information and support. A subreddit dedicated to contraception, r/birthcontrol, provides a platform for people to post about contraception.

OBJECTIVE

This study explored the use of r/birthcontrol, from the inception of the subreddit through the end of 2020. We describe the web-based community, identify distinctive interests and themes based upon the textual content of posts, and explore the content of posts with the most user engagement (ie, "popular" posts).

METHODS

Data were obtained from the PushShift Reddit application programming interface from the establishment of r/birthcontrol to the start date of analysis (July 21, 2011, to December 31, 2020). User interactions within the subreddit were analyzed to describe community use over time, specifically the commonality of use based on the volume of posts, the length of posts (character count), and the proportion of posts with any and each flair applied. "Popular" posts on r/birthcontrol were determined based on the number of comments and "scores," or upvotes minus downvotes; popular posts had 9 comments and a score of ≥3. Term Frequency-Inverse Document Frequency (TF-IDF) analyses were run on all posts with flairs applied, posts within each flair group, and popular posts within each flair group to characterize and compare the distinctive language used in each group.

RESULTS

There were 105,485 posts to r/birthcontrol during the study period, with the volume of posts increasing over time. Within the time frame for which flairs were available on r/birthcontrol (after February 4, 2016), users applied flairs to 78% (n=73,426) of posts. Most posts contained exclusively textual content (n=66,071, 96%), had comments (n=59,189, 86%), and had a score (n=66,071, 96%). Posts averaged 731 characters in length (median 555). "SideEffects!?" was the most frequently used flair overall (n=27,530, 40%), while "Experience" (n=719, 31%) and "SideEffects!?" (n=672, 29%) were most common among popular posts. TF-IDF analyses of all posts showed interest in contraceptive methods, menstrual experiences, timing, feelings, and unprotected sex. While TF-IDF results for posts with each flair varied, the contraceptive pill, menstrual experiences, and timing were discussed across flair groups. Among popular posts, intrauterine devices and contraceptive use experiences were often discussed.

CONCLUSIONS

People commonly wrote about contraceptive side effects and experiences using methods, highlighting the value of r/birthcontrol as a space to post about aspects of contraceptive use that are not well addressed by clinical contraceptive counseling. The value of real-time, open-access data on contraceptive users' interests is especially high given the shifting landscape of and increasing constraints on reproductive health care in the United States.

"I'm going to be forced to have a baby": A study of COVID-19 abortion experiences on Reddit

INTRODUCTION

The initial stages of the COVID-19 pandemic affected abortion care in the United States (US) in myriad ways. While research has documented systems-level pandemic-related impacts on abortion access and care delivery little information exists about the experiences of abortion seekers during this period. We sought to document the effects of COVID-19 pandemic restrictions US abortion seekers by analyzing posts on Reddit, a popular social media website.

METHODS

We compiled and coded 528 anonymous posts on the abortion subreddit from 3/20/2020 to 4/12/2020 and applied inductive qualitative analytic techniques to identify themes.

RESULTS

We identified four primary themes. First, posters reported several COVID-19-related barriers to abortion services: reduced in-person access due to clinic closures, mail delivery delays of abortion medications, and pandemic-related financial barriers to both self-managed and in-clinic abortion. The second theme encompassed quarantine-driven privacy challenges, primarily challenges with concealing an abortion from household members. Third, posters detailed how the pandemic constrained their pregnancy decision making, including time pressure from impending clinic closures. Finally, posters reported COVID-19-related changes to service delivery that negatively affected their abortion experiences, for example being unable to bring a support person into the clinic due to pandemic visitor restrictions.

DISCUSSION

This analysis of real-time social media posts reveals multiple ways that the COVID-19 pandemic limited abortion access in the US and affected abortion seekers' decisions and experiences. Findings shed light on the consequences of sudden changes, whether pandemic or policy related, on abortion service delivery.

"Am I the Only One Who Feels Like This?": Needs Expressed Online by Abortion Seekers

In the United States, abortion is safe and common, but highly stigmatized and frequently targeted by legislation that aims to restrict access. Numerous obstacles impede access to abortion care, including logistical barriers like cost and transportation, limited clinic availability, and state-mandated waiting periods. Accurate abortion information can also be hard to access. To overcome these barriers, many people seeking abortion turn to anonymous online forums, including Reddit, for information and support. Examining this community provides a unique perspective on the questions, thoughts, and needs of people considering or undergoing an abortion. The authors web scraped 250 posts from subreddits that contain abortion-related posts, then coded deidentified posts using a combined deductive/inductive approach. The authors identified a subset of these codes in which users were giving/seeking information and advice on Reddit, then engaged in a targeted analysis of the needs expressed in these posts. Three interconnected needs emerged: (1) need for information, (2) need for emotional support, and (3) need for community around the abortion experience. In this study map the authors reflected these needs onto key social work practice areas and competencies; taken alongside support from social work's governing bodies, this research suggests that social workers would be beneficial additions to the abortion care workforce.

Social media use and body image issues among adolescents in a vulnerable Louisiana community

Widespread concern has been expressed regarding unrealistic body image and adolescent eating disorder promoting content on social media (SM) platforms. Numerous research studies have examined the impact of SM on body image as well as social vulnerability on negative mental health outcomes. Despite this, few previous studies have examined the impact of SM on body image specifically in vulnerable, underserved, or predominantly minority communities. This study examines the impact of SM on body image issues (BII) in adolescents in a public school system where greater than 50% of the students live in impoverished households. In late 2019, high school student leaders in Northwest Louisiana developed a survey alongside Step Forward, a collective impact initiative. Questions investigated adolescent SM use and mental health in Caddo Parish, namely BII. Teachers within Caddo Parish Public School System administered the survey. Out of the 11,248 total high school students in the school system, nearly 50% were sampled for a sample size of 5,070. Hypotheses included: (1) females were more likely to use SM than males, (2) increasing time spent on SM would correlate with females reporting BII, with males remaining largely unaffected, and (3) highly visual social media (HVSM) platforms would be associated with greater reports of BII than non-HVSM platforms. Results showed females were more likely to use SM (p < 0.001) and report BII (p < 0.001) compared to males, while both sexes reported BII with increasing time spent on SM (p < 0.001). A diversity of platforms were associated with increased BII among SM users compared to non-users (p < 0.001): Pinterest, Reddit, Snapchat, TikTok, Twitter, and YouTube. This conclusion is tempered by the omission of race as a variable in the study design, the use of self-report, and the use of an unvalidated instrument. These findings suggest that the harmful association between SM use and BII may transcend culture and socioeconomic status for a broadly deleterious effect on adolescent mental wellbeing.

A Content Analysis of Reddit Users' Posts about Challenges to Contraceptive care-seeking during COVID-19-related Restrictions in the United States

The COVID-19 pandemic in the United States caused disruptions in care seeking and delivery during the spring of 2020, including for contraceptive care. We examined how some individuals experienced and responded to barriers to accessing contraceptive care by conducting a content analysis of relevant Reddit posts. We collected 2666 posts by scraping relevant subreddits from February 1, 2020, to April 15, 2020, and filtering by selected keywords. Among the 101 posts on contraception and the COVID-19 pandemic, we explored three main themes: barriers to accessing general healthcare during the early pandemic, problems and concerns specific to contraceptive use, and attempts to navigate the obstacles to contraceptive care or use-related concerns. The Reddit posts demonstrated the disruptive force the early pandemic had on contraceptive care and provided a unique window into the concerns posters expressed on Reddit during this time. Many posters asked questions related to accessing contraception and side effects and sought reassurance from these online forums. Our results suggest that there were barriers to accessing reliable, high-quality, and evidence-based information about contraception during this disruption in care. The findings also underscore that conversational and interactive means of seeking out information are important modes for learning about and discussing contraception for some and may be especially helpful during clinic closures and other restrictions on access.

Experiences of Mental Distress during COVID-19: Thematic Analysis of Discussion Forum Posts for Anxiety, Depression, and Obsessive-Compulsive Disorder

The psychological impact of the COVID-19 pandemic on coronavirus patients, health care workers, and the general population is clear. Relatively few studies have, however, considered the impact of the pandemic on those with pre-existing mental health conditions. Therefore, the present study investigates the personal experiences of those with anxiety, depression, and obsessive-compulsive disorder during COVID-19. We conducted a qualitative study utilising Reddit discussion forum posts. We conducted three separate thematic analyses from 130 posts in subreddit forums aimed for people identifying with anxiety, depression, and obsessive-compulsive disorder. We identified a number of similar discussion forum themes (e.g., COVID-19 intensifying symptoms and a lack of social support), as well as themes that were unique to each forum type (e.g., hyperawareness and positive experiences during the pandemic). Findings should guide future practice and the support provided to those living with mental distress.

Exploring the Experiences of People who Engage with Pro-eating Disorder Online Media: A Qualitative Inquiry

The harmful consequences of eating disorders can impact an individual’s physical, emotional, and psychosocial wellness. However, these consequences may be exacerbated by the use of pro-eating disorder online media. In this study, we used a hermeneutic phenomenological qualitative inquiry to explore the experiences of an international sample of adults engaging with pro-eating disorder online media. Analysis revealed themes and subthemes and provided context for meaning(s) individuals experience when engaging in pro-eating disorder media. Implications for counsellors across the globe are discussed.

Exploring the Posting of Nude Photographs on Reddit in Relation to Self-Esteem, Perceived Attractiveness, Narcissism, and Sensation Seeking

While many scholars have explored the sharing of nude photographs one-to-one (i.e., sexting), few have examined the sharing of nudity in a one-to-many context. The current study examined the sharing of nude photographs on Reddit, framing the practice as an act of disinhibited online behavior. A survey (n = 628) was conducted to assess whether Redditors levels of sensation seeking, self-esteem, perceived attractiveness, and narcissism would be related to whether or not they posted nude photographs on the site. Results indicated that posting nudity on Reddit was significantly associated with higher perceived attractiveness and narcissism, but not sensation seeking or self-esteem. The role of gender and sexual orientation in the posting of nudity online was also assessed, and an overrepresentation of nude content produced by females and bisexual persons, as well as an underrepresentation of nude content produced by males and heterosexuals, was found. Findings are discussed in relation to self-concept, sexual health, and the online disinhibition effect.

Experiences, Motivations, and Perceived Impact of Participation in a Facebook-Based Support Group for Caregivers of Children and Youth With Complex Care Needs: Qualitative Descriptive Study

BACKGROUND

Caregivers of children and youth with complex care needs (CCNs) often require considerable support to ensure the well-being of their families. Social media present an opportunity to better support caregivers through computer-mediated communication for social support. Peer-to-peer (P2P) support groups are a way in which caregivers are accessing needed support; however, the experiences of caregivers who use these groups and the perceived impact that participation has on caregivers of children and youth with CCNs are not known.

OBJECTIVE

This study aimed to explore the experiences of caregivers of children and youth with CCNs who use a Facebook-based P2P support group to communicate, understand their motivations to use the group, and investigate its perceived impact on knowledge of programs and services and sense of community belonging among caregivers.

METHODS

A qualitative descriptive design was used to explore the experiences and perceived impact of a Facebook-based (Meta Platforms) P2P support group for caregivers of children and youth with CCNs in New Brunswick, Canada. The group was launched on the web in October 2020, during the COVID-19 pandemic, and resulted in 108 caregivers joining the group. A web-based survey was distributed, and semistructured interviews were conducted in February 2021 with a subsample of members. Thematic analysis was used to identify and report patterns related to caregivers' experiences and perceived impacts of participation.

RESULTS

A subsample of members in the Facebook group completed the web-based survey (39/108, 36.1%) and interviews (14/108, 12.9%). A total of 5 themes emerged from the interviews: safe space, informational support and direction, web-based connection with peers, impact on knowledge of programs and services, and degree of community belonging. Participants reported joining the group to obtain geography-specific information support and connect with peers. Many participants reported an improvement in their knowledge of programs and services and felt connected to the community; however, the short observation period and diversity among the caregiver population were cited as barriers to community belonging.

CONCLUSIONS

Social media present an important opportunity to facilitate the exchange of support between patients and caregivers in an accessible and curated environment. Findings from this study suggest that involvement in web-based, geography-specific P2P support groups can influence perceived knowledge of services and resources and sense of community belonging among caregivers of children and youth with CCNs. Furthermore, this study provides insight into the experiences and motivations of caregivers of children and youth with CCNs who participate in a private social media environment.

Exploring the Use of a Facebook-Based Support Group for Caregivers of Children and Youth With Complex Care Needs: Qualitative Descriptive Study

BACKGROUND

Caregivers of children and youth with complex care needs (CCN) require substantial support to ensure the well-being of their families. Web-based peer-to-peer (P2P) support groups present an opportunity for caregivers to seek and provide timely informational and emotional support. Despite the widespread use of social media for health-related support across diverse patient and caregiver populations, it is unclear how caregivers of children and youth with CCN use and potentially benefit from these groups.

OBJECTIVE

The aim of this study is to explore the use of a web-based P2P support group for caregivers of children and youth with CCN in New Brunswick, Canada, and investigate factors related to its use by members.

METHODS

The study sample consisted of individuals who joined a closed Facebook group and an analysis of content published to the group. In phase 1, a Facebook group was developed in consultation with a patient and family advisory council, and members were recruited to the group. Phase 2 of this study consisted of an observation period during which posts and related interactions (ie, likes, loves, and comments) by members were collected. In phase 3, a web-based survey was distributed, and semistructured interviews were conducted with a subsample of group members. Survey and interview data were analyzed using thematic analysis.

RESULTS

A total of 108 caregivers joined the Facebook group between October 2020 and March 2021. There were 93 posts with 405 comments and 542 associated interactions (448/542, 82.7% likes and 94/542, 17.3% loves). Of these 93 posts, 37 (40%) were made by group members, and 56 (60%) were made by moderators. Of the 108 members, a subsample of 39 (36.1%) completed a web-based survey, and 14 (13%) participated in the interviews. Content analyses of posts by members revealed that inquiry (17/37, 46%), informational (15/37, 41%), and emotional posts (4/37, 11%) were the most common. Emotional posts received the highest number of interactions (median 24.5). In total, 5 themes emerged from the interviews related to the use of the group and mediating factors of interactions between group members: resource for information, altruistic contribution, varying level of engagement, perceived barriers to and facilitators of group activity, and moderators as contributing members.

CONCLUSIONS

These findings demonstrate that caregivers of children and youth with CCN seek geography-specific P2P support groups to meet informational and social support needs. This study contributes to the knowledge on how caregivers use Facebook groups to meet their support needs through moderate and passive engagement.

What Topics Do Members of the Eating Disorder Online Community Discuss and Empathize with? An Application of Big Data Analytics

Given the stigma of eating disorders (EDs), anonymous online communities of individuals with EDs can play a critical role in their treatment. In our study, we aimed to identify prevalent topics related to EDs in one community. To discover latent topics in an online community dedicated to EDs, we applied an automated text-mining approach to topic modeling after collecting data from Reddit created between January 2011 and September 2020. As a result of topic modeling, topics regarding emotional support, informational support, and inquiries about EDs were discovered. In frequently asked questions and advice about EDs in the online community, community members empathized more with topics soliciting emotional support rather than informational support. Despite the importance of online communities, studies on this topic, especially those analyzing online conversations, have remained limited. By demonstrating the role of online communities in supplementary interventions, our findings can support clinicians in caring for patients with EDs.

#EatingDisorderRecovery: a qualitative content analysis of eating disorder recovery-related posts on Instagram

PURPOSE

Limited research has evaluated the role of Social Networking Sites (SNS) in eating disorder (ED) recovery. While research has demonstrated the deleterious effects of pro-ED SNS content, less is known regarding SNS content documenting ED recovery. This study evaluates orientation towards help-seeking, ongoing ED warning signs and recovery themes on ED recovery SNS hashtags.

METHODS

600 Instagram posts were retrieved from two popular hashtags: #EDrecovery and #EatingDisorderRecovery. They were categorized into four thematic concerns: Food, Quotes, People or Others. Posts were analysed for behavioural and psychological signs of ED based on the Mental Health First Aid Eating Disorders Guidelines, and whether they encouraged seeking professional help. Thematic qualitative analysis to evaluate themes posted on recovery hashtags was conducted.

RESULTS

Of the 600 posts, 405 were used for analysis. The majority of posts were on Food (49.6%), Quotes (24.2%) and People (22.7%). Behavioural and psychological signs suggestive of EDs were present in 18.0% and 22.5% of images, respectively. Only 9.4% of posts encouraged seeking professional help. Important themes that emerged from the qualitative analysis included the recovery journey, increased awareness and stigma for EDs and the development of a supportive community.

CONCLUSIONS

Despite identifying with ED recovery, posts had a high prevalence of ongoing ED behaviour and low prevalence of help-seeking. Thematic analysis emphasized the role of recovery as a journey and the role of stigma and community in recovery. These findings suggest that SNSs could potentially be leveraged as a platform to improve help-seeking and encourage recovery for users with eating disorders.

LEVEL OF EVIDENCE

Level V, descriptive study.

Critical measurement issues in the assessment of social media influence on body image

Progress towards understanding how social media impacts body image hinges on the use of appropriate measurement tools and methodologies. This review provides an overview of common (qualitative, self-report survey, lab-based experiments) and emerging (momentary assessment, computational) methodological approaches to the exploration of the impact of social media on body image. The potential of these methodologies is detailed, with examples illustrating current use as well as opportunities for expansion. A key theme from our review is that each methodology has provided insights for the body image research field, yet is insufficient in isolation to fully capture the nuance and complexity of social media experiences. Thus, in consideration of gaps in methodology, we emphasise the need for big picture thinking that leverages and combines the strengths of each of these methodologies to yield a more comprehensive, nuanced, and robust picture of the positive and negative impacts of social media.

How essential is kratom availability and use during COVID-19? Use pattern analysis based on survey and social media data

Background: Kratom, a tree native to Southeast Asia, is increasingly used in Western countries for self-treatment of pain, psychiatric disorders, and mitigation of withdrawal symptoms from drugs of abuse. Because kratom is solely supplied from its native locations, supply shortages during the COVID-19 pandemic may impact the availability of preparations and hence force consumers to change their patterns of use. The aim of this study was to understand if and how COVID-19 was influencing kratom purchasing and use. Methods: Additional questions specific to kratom availability and changes in use during COVID-19 were added to an international online survey with responses collected between January and July 2020. During the same period, kratom-related social media posts to Twitter, Reddit, and Bluelight were analyzed for themes similar to the survey questions. Results: The survey results indicated no changes in kratom use patterns although the sample size was relatively small (n = 70) with younger consumers reporting a potential issue in obtaining their desired products from their usual sources. The survey respondents identified primarily as non-Hispanic whites (87.1%). Social media themes revolved primarily around quitting kratom during COVID-19, misinformation about the effects of kratom on COVID-19, and other non-COVID-related discussions. While some consumers may increase their kratom dose because of additional stress, a majority of discussions centered around reducing or rationing kratom due to COVID-19 or a perceived dependence. Access to quality kratom products was also a major discussion topic on social media. Conclusions: Kratom use patterns did not change due to COVID-19 but consumers were concerned about potential product shortages and resulting quality issues. Clinicians and public health officials need to be informed and educated about kratom use as a potential mitigation strategy for substance use disorders and for self-treatment of pain.

Determining the prevalence of cannabis, tobacco, and vaping device mentions in online communities using natural language processing

INTRODUCTION

The relationship between cannabis, tobacco, and vaping devices is both rapidly changing and poorly understood, with consumers rapidly shifting between use of all three product types. Given this dynamic and evolving landscape, there is an urgent need to monitor and better understand co-use, dual-use, and transition patterns between these products. This study describes work that utilizes social media - in this case, Reddit - in conjunction with automated Natural Language Processing (NLP) methods to better understand cannabis, tobacco, and vaping device product usage patterns.

METHODS

We collected Reddit data from the period 2013-2018, sourced from eight popular, high-volume Reddit communities (subreddits) related to the three product categories. We then manually annotated (coded) a set of 2640 Reddit posts and trained a machine learning-based NLP algorithm to automatically identify and disambiguate between cannabis or tobacco mentions (both smoking and vaping) in Reddit posts. This classifier was then applied to all data derived from the eight subreddits, 767,788 posts in total.

RESULTS

The NLP algorithm achieved an overall moderate performance (overall F-score of 0.77). When applied to our large corpus of Reddit posts, we discovered that over 10% of posts in the smoking cessation subreddit r/stopsmoking were classified as referring to vaping nicotine, and that only 2% of posts from the subreddits r/electronic_cigarette and r/vaping were classified as referring to smoking (tobacco) cessation.

CONCLUSIONS

This study presents the results of applying an NLP algorithm designed to identify and distinguish between cannabis and tobacco mentions (both smoking and vaping) in Reddit posts, hence contributing to our currently limited understanding of co-use, dual-use, and transition patterns between these products.

e-Cigarette Cessation: Content Analysis of a Quit Vaping Community on Reddit

Background

e-Cigarette use, also known as vaping, has increased dramatically over the past few years, especially among younger demographics. However, researchers have found that a large number of e-cigarette users want to quit. Little is known about the unique aspects of vaping cessation, which is critical to informing the development of relevant resources and interventions for e-cigarette users who want to quit. Social media forums such as Reddit provide opportunities to understand the experiences of behavior change such as quitting vaping from the perspective of end users.

Objective

This study aims to examine a quit vaping subreddit to understand how e-cigarette users are experiencing and approaching vaping cessation. Specifically, we examine methods used to approach quitting, reasons for quitting, and barriers and facilitators to quitting.

Methods

A total of 1228 posts were collected. The posts were inductively coded to generate categories and subcategories using conventional content analysis. Data were analyzed using the NVivo 12 qualitative data analysis software.

Results

Most users reported a preference for approaching quitting through gradual reduction, particularly through the use of their own devices by tapering the nicotine content. Their reasons for quitting were primarily related to experiencing negative physical consequences associated with vaping, especially in relation to their lungs (eg, tight chest), and tired of feeling stuck to the vape because of nicotine addiction. Top barriers to quitting were related to withdrawal symptoms and intensity of addiction. The top facilitators to quitting were related to using distraction techniques (eg, hobby, gaming, and mindfulness exercises), as well as having a positive mindset.

Conclusions

The findings of this study reveal unique aspects that encompass the process of quitting vaping. These findings have significant implications for both policy and intervention development.

Reddit use in the LIS community

This study examined online communications within library and information science (LIS)-related subreddits through the perspectives of social identity theory and social media engagement. A total of 17,049 Reddit posts from three major LIS-related subreddits were harvested through Pushshift by Python. Manual and computational coding methods were used to identify linguistic characteristics of the posts as well as the topicality of the content. Multiple logistic regressions were used to analyze the relationship between psychological and emotional characteristics of the posts and user engagement. Results showed that the majority of posts did not mention a specific type of LIS organization; of the subset that did, public libraries and academic libraries were most frequently referenced. “Library services and usage” was the topic most mentioned within LIS-related subreddits, followed by “librarians and jobs.” Various psychological features of posts including emotional tone score, authentic score, clout score, analytic score, and usage of words related to affective processes, anxiety, social processes, causation, and time were significantly related to user engagement. This study contributes to further understanding of social identity theory and social media engagement within the online communication context of LIS community. Key topics and issues in the LIS field and practical suggestions for strategies to improve social media engagement across LIS community were discussed.

Detrimental Effects of Online Pro-Eating Disorder Communities on Weight Loss and Desired Weight: Longitudinal Observational Study

BACKGROUND

Online pro-eating disorder (pro-ED) communities are considered harmful because of their detrimental effects on their users' body dissatisfaction, dieting, and help seeking. To date, it is unknown to which extent participation in pro-ED communities affects users' body weight and desired weight loss.

OBJECTIVE

This study aims to investigate the changes in the current and desired body weight of users of a pro-ED community (r/proed) on the social media website Reddit over time.

METHODS

Data on 1170 users and the unsolicited weight information they shared with the pro-ED community were collected over a period of 15 months. Linear growth models were used to model changes in the users' current and desired BMI over time.

RESULTS

Both current and desired BMI decreased over time, with a predicted rate of 0.087 and 0.015 BMI points per week, respectively. Weight loss was moderated by the users' activity level in the community, with more active users losing more weight. Users with a higher baseline BMI experienced greater weight loss, but even users with a very low baseline weight (BMI <17 kg/m²) lost weight during their participation. In addition, users decreased their desired weight over time, with many pursuing extremely low, unrealistic weight goals. Changes in the desired weight were moderated by the baseline current BMI and baseline desired BMI. Users with higher desired weight and lower body weight at baseline decreased their desired weight more over time.

CONCLUSIONS

This is the first study to demonstrate the detrimental effects of pro-ED communities in a longitudinal study based on a large data set of user-generated online data. The results extend the literature detailing the harmful effects of online pro-ED communities by showing users' weight loss, decreases in desired weight, and that higher activity levels lead to greater weight loss. Users could be driven to pursue very low, unrealistic weight loss goals by images of very thin bodies presented in these communities.

Peer-to-Peer Social Media Communication About Dietary Supplements Used for Weight Loss and Sports Performance Among Military Personnel: Pilot Content Analysis of 11 Years of Posts on Reddit

Background

Over 60% of military personnel in the United States currently use dietary supplements. Two types of dietary supplements, weight loss and sports performance (WLSP) supplements, are commonly used by military personnel despite the associated serious adverse effects such as dehydration and stroke.

Objective

To understand peer-to-peer communication about WLSP supplements among military personnel, we conducted a pilot study using the social media website, Reddit.

Methods

A total of 64 relevant posts and 243 comments from 2009 to 2019 were collected from 6 military subreddits. The posts were coded for year of posting, subreddit, and content consistent with the following themes: resources about supplement safety and regulation, discernability of supplement use through drug testing, serious adverse effects, brand names or identifiers, and reasons for supplement use.

Results

A primary concern posted by personnel who used supplements was uncertainty about the supplements that were not detectable on a drug test. Supplements to improve workout performance were the most frequently used.

Conclusions

Our pilot study suggests that military personnel may seek out peer advice about WLSP supplements on Reddit and spread misinformation about the safety and effectiveness of these products through this platform. Future directions for the monitoring of WLSP supplement use in military personnel are discussed.

Therapeutic benefit with caveats?: Analyzing social media data to understand the complexities of kratom use

BACKGROUND

Mitragyna speciosa, referred to as "kratom", is increasingly used in the United States for self-treating pain, psychiatric, and substance use disorder symptoms. It is used by some to attenuate opioid withdrawal and as a longer-term drug substitute. Most self-report data have come from online surveys, small in-person surveys, and case reports. These may not be representative of the broader kratom-using population.

PURPOSE

Analyze user-generated social media posts to determine if independent, descriptive accounts are generally consistent with prior U.S. kratom survey findings and gain a more nuanced understanding of kratom use patterns.

METHODS

Reddit posts mentioning kratom from 42 subreddits between June 2019-July 2020 were coded by two independent raters.

FINDINGS

Relevant posts (number of comments, upvotes, and downvotes) from 1274 posts comprised the final sample (n = 280). Of the 1521 codes applied, 1273 (83.69%) were concordant. Desirable kratom effects were described among a majority, but so too were adverse effects. Reports of kratom as acute self-treatment for opioid withdrawal were more prominent compared to longer-term opioid substitution. Quantitative analysis found higher kratom doses associated (p < .001) with greater odds of reported kratom addiction (OR = 3.56) or withdrawal (OR = 5.88), with slightly lower odds of desirable effects (OR = 0.53, p = .014). Despite perceived therapeutic benefits, kratom was characterized by some in terms of addiction that, in some cases, appeared dose-dependent. Polydrug use was also prominently discussed.

CONCLUSIONS

Results validated many prior survey findings while illustrating complexities of kratom use that are not being fully captured and require continued investigation.

"Compulsive exercise is a socially acceptable prison cell": Exploring experiences with compulsive exercise across social media

OBJECTIVE

Investigations into online eating disorder (ED) communities have allowed for a rich exploration of lived experiences focused on a number of aspects, such as recovery and support groups. There is a lack of understanding around compulsive exercise (CE), which is often a characterizing condition of EDs. Exploring the lived experiences of CE as discussed online could provide helpful insight towards a better understanding of CE. Therefore, the purpose of this study was to explore experiences around CE and EDs shared on social media sites.

METHOD

Social media posts related to CE and EDs from Reddit, Twitter, Instagram, and forums were collected for 12 months. A thematic analysis of 881 posts was used to identify common themes among individuals' lived experiences with CE.

RESULTS

Five themes (and three subthemes) were identified across the social media posts: (1) seeking control, but ultimately CE takes hold, (2) burning off binges, but at what expense?, (3) recovery is a battle, but worth it, (4) is my exercise healthy?, and (5) frustration with comments about CE.

DISCUSSION

The lived experiences of CE among individuals with EDs have provided support for current definitions of CE and shared novel insight into the recovery experience. Individuals online also highlighted the need for improvement in treatment around CE specifically, and greater awareness around CE for the general public and healthcare providers.

Real-Time Effects of Payer Restrictions on Reproductive Healthcare: A Qualitative Analysis of Cost-Related Barriers and Their Consequences among U.S. Abortion Seekers on Reddit

Objective: The Hyde Amendment and related policies limit or prohibit Medicaid coverage of abortion services in the United States. Most research on cost-related abortion barriers relies on clinic-based samples, but people who desire abortions may never make it to a healthcare center. To examine a novel, pre-abortion population, we analyzed a unique qualitative dataset of posts from Reddit, a widely used social media platform increasingly leveraged by researchers, to assess financial obstacles among anonymous posters considering abortion. Methods: In February 2020, we used Python to web-scrape the 250 most recent posts that mentioned abortion, removing all identifying information and usernames. After transferring all posts into NVivo, a qualitative software package, the team identified all datapoints related to cost. Three qualitatively trained evaluators established and applied codes, reaching saturation after 194 posts. The research team used a descriptive qualitative approach, using both inductive and deductive elements, to identify and analyze themes related to financial barriers. Results: We documented multiple cost-related deterrents, including lack of funds for both the procedure and attendant travel costs, inability to afford desired abortion modality (i.e., medication or surgical), and for some, consideration of self-managed abortion options due to cost barriers. Conclusions: Findings from this study underscore the centrality of cost barriers and third-party payer restrictions to stymying reproductive health access in the United States. Results may contribute to the growing evidence base and building political momentum focused on repealing the Hyde Amendment.

Associations of COVID-19 online information sources and information overload with psychological distress symptoms: a population-based study

Using information communication technologies as information sources of COVID-19 was associated with psychological problems, but mechanisms remain uncertain. We examined associations of COVID-19 information sources and information overload with psychological distress symptoms and explored the mediating effect of information overload in Hong Kong. A random sample of Chinese adults (N = 1501; 52.6% females; 55.0% aged 30-59) from dual landline and online surveys in April 2020 reported frequency of using traditional media, internet websites, social networking sites, instant messaging, and online discussion forums as COVID-19 information sources. Psychological distress symptoms were measured using the Patient Health Questionnaire 4-item ([PHQ-4]; 0-12). Information overload defined as a perception of being overwhelmed was measured (1-6). Linear regressions were performed to analyze the associations, and the mediating effect of information overload was examined. Greater PHQ-4 score was observed for frequent use of internet websites (adjusted b = 0.58, 95% CI 0.29, 0.87, adjusted β = 0.12) and online discussion forums (adjusted b = 0.39, 95% CI 0.08, 0.70, adjusted β = 0.08) and information overload (adjusted b = 0.54, 95% CI 0.44, 0.63, adjusted β = 0.28). Information overload mediated 44.9% and 36.9% of associations of frequent use of internet websites and online discussion forums with PHQ-4 score, respectively. Frequent use of social networking sites was associated with lower PHQ-4 score (adjusted b = -0.37, 95% CI -0.69, -0.04, adjusted β = -0.07) partially through lower information overload (37.5%). Psychological distress symptoms were associated with frequent use of internet websites and online discussion forums as COVID-19 information sources, which were mediated through information overload.

COVID-19 Pandemic Impact on Substance Misuse: A Social Media Listening, Mixed Method Analysis

The restrictive measures adopted during the COVID-19 pandemic modified some previously consolidated drug use patterns. A focus on social networks allowed drug users to discuss, share opinions and provide advice during a worldwide emergency context. In order to explore COVID-19-related implications on drug trends/behaviour and on most popular psychotropic substances debated, the focus here was on the constantly updated, very popular, Reddit social platform’s posts and comments. A quantitative and qualitative analysis of r/Drugs and related subreddits, using a social media listening netnographic approach, was carried out. The post/comments analysed covered the time-frame December 2019–May 2020. Between December 2019 and May 2020, the number of whole r/Drugs subreddit members increased from 619,563 to 676,581 members, respectively, thus increasing by 9.2% by the end of the data collection. Both the top-level r/Drugs subreddit and 92 related subreddits were quantitatively analysed, with posts/comments related to 12 drug categories. The drugs most frequently commented on included cannabinoids, psychedelics, opiates/opioids, alcohol, stimulants and prescribed medications. The qualitative analysis was carried out focussing on four subreddits, relating to some 1685 posts and 3263 comments. Four main themes of discussion (e.g., lockdown-associated immunity and drug intake issues; drug-related behaviour/after-quarantine plans’ issues; lockdown-related psychopathological issues; and peer-to-peer advice at the time of COVID-19) and four categories of Redditors (e.g., those continuing the use of drugs despite the pandemic; the “couch epidemiologists”; the conspirationists/pseudo-science influencers; and the recovery-focused users) were tentatively identified here. A mixed-methods, social network-based analysis provided a range of valuable information on Redditors’ drug use/behaviour during the first phase of the COVID-19 pandemic. Further studies should be carried out focusing on other social networks as well as later phases of the pandemic.

Changes in Language Style and Topics in an Online Eating Disorder Community at the Beginning of the COVID-19 Pandemic: Observational Study

BACKGROUND

COVID-19 has affected individuals with lived experience of eating disorders (EDs), with many reporting higher psychological distress, higher prevalence of ED symptoms, and compensatory behaviors. The COVID-19 pandemic and the health and safety measures taken to contain its spread also disrupted routines and reduced access to familiar coping mechanisms, social support networks, and health care services. Social media and the ED communities on social media platforms have been an important source of support for individuals with EDs in the past. So far, it is unknown how discussions in online ED communities changed as offline support networks were disrupted and people spent more time at home in the first months of the COVID-19 pandemic.

OBJECTIVE

The aim of this study is to identify changes in language content and style in an online ED community during the initial onset of the COVID-19 pandemic.

METHODS

We extracted posts and their comments from the ED community on the social media website Reddit and concatenated them to comment threads. To analyze these threads, we applied top-down and bottom-up language analysis methods based on topic modeling with latent Dirichlet allocation and 13 indicators from the Linguistic Inquiry and Word Count program, respectively. Threads were split into prepandemic (before March 11, 2020) and midpandemic (after March 11, 2020) groups. Standardized mean differences were calculated to estimate change between pre- and midpandemic threads.

RESULTS

A total of 17,715 threads (n=8772, 49.5% prepandemic threads; n=8943, 50.5% midpandemic threads) were extracted from the ED community and analyzed. The final topic model contained 21 topics. CIs excluding zero were found for standardized mean differences of 15 topics and 9 Linguistic Inquiry and Word Count categories covering themes such as ED symptoms, mental health, treatment for EDs, cognitive processing, social life, and emotions.

CONCLUSIONS

Although we observed a reduction in discussions about ED symptoms, an increase in mental health and treatment-related topics was observed at the same time. This points to a change in the focus of the ED community from promoting potentially harmful weight loss methods to bringing attention to mental health and treatments for EDs. These results together with heightened cognitive processing, increased social references, and reduced inhibition of negative emotions detected in discussions indicate a shift in the ED community toward a pro-recovery orientation.

Characterization of time-variant and time-invariant assessment of suicidality on Reddit using C-SSRS

Suicide is the 10th leading cause of death in the U.S (1999-2019). However, predicting when someone will attempt suicide has been nearly impossible. In the modern world, many individuals suffering from mental illness seek emotional support and advice on well-known and easily-accessible social media platforms such as Reddit. While prior artificial intelligence research has demonstrated the ability to extract valuable information from social media on suicidal thoughts and behaviors, these efforts have not considered both severity and temporality of risk. The insights made possible by access to such data have enormous clinical potential-most dramatically envisioned as a trigger to employ timely and targeted interventions (i.e., voluntary and involuntary psychiatric hospitalization) to save lives. In this work, we address this knowledge gap by developing deep learning algorithms to assess suicide risk in terms of severity and temporality from Reddit data based on the Columbia Suicide Severity Rating Scale (C-SSRS). In particular, we employ two deep learning approaches: time-variant and time-invariant modeling, for user-level suicide risk assessment, and evaluate their performance against a clinician-adjudicated gold standard Reddit corpus annotated based on the C-SSRS. Our results suggest that the time-variant approach outperforms the time-invariant method in the assessment of suicide-related ideations and supportive behaviors (AUC:0.78), while the time-invariant model performed better in predicting suicide-related behaviors and suicide attempt (AUC:0.64). The proposed approach can be integrated with clinical diagnostic interviews for improving suicide risk assessments.

Experiences of Intimate Partner Violence during Lockdown and the COVID-19 Pandemic

Previous studies have demonstrated that there is an increase in Intimate Partner Violence (IPV) during times of crisis (e.g., financial, environmental, or socio-political situations). The COVID-19 pandemic has triggered an unprecedented global health and financial tragedy, but research is yet to establish exactly how the situation may impact on IPV. The present study investigates victims' experience of IPV during lockdown and the COVID-19 pandemic. We report a qualitative thematic analysis of 50 discussion forum posts written by victims of IPV. Of these, 48 forum posts were written by female victims of male perpetrated violence. All forum posts were obtained from the popular online platform, Reddit. We identified four themes associated with IPV victims' experiences during lockdown and the global pandemic: (i) Use of COVID-19 by the Abuser, (ii) Service Disruption, (iii) Preparation to Leave, and (iv) Factors Increasing Abuse or Distress. The COVID-19 pandemic has had a substantial impact on those living with IPV, often increasing the severity of IPV experienced. The experiences of those affected by IPV during this period inform interventions and the guidance and support provided to IPV victims during times of crisis.

"How will I get my next week's script?" Reactions of Reddit opioid forum users to changes in treatment access in the early months of the coronavirus pandemic

BACKGROUND

The COVID-19 pandemic poses significant challenges to people with opioid use disorder (OUD). As localities enforce lockdowns and pass emergency OUD treatment regulations, questions arise about how these changes will affect access and retention in care. In this study, we explore the influence of COVID-19 on access to, experiences with, and motivations for OUD treatment through a qualitative analysis of public discussion forums on Reddit.

METHODS

We collected data from Reddit, a free and international online platform dedicated to public discussions and user-generated content. We extracted 1000 of the most recent posts uploaded between March 5th and May 13th, 2020 from each of the two most popular opioid subreddits "r/Opiates" and "r/OpiatesRecovery" (total 2000). We reviewed posts for relevance to COVID-19 and opioid use and coded content using a hybrid inductive-deductive approach. Thematic analysis identified common themes related to study questions of interest.

RESULTS

Of 2000 posts reviewed, 300 (15%) discussed topics related to the intersection of opioid use and COVID-19. Five major themes related to OUD treatment were identified: Concern about closure of OUD treatment services; transition to telehealth and virtual care; methadone treatment requirements and increased exposure to COVID-19; reactions to changing regulations on medications for OUD; and influences of the pandemic on treatment motivation and progress.

CONCLUSION

In the face of unprecedented challenges due to COVID-19, reactions of Reddit opioid forum users ranged from increased distress in accessing and sustaining treatment, to encouragement surrounding new modes of treatment and opportunities to engage in care. New and less restrictive avenues for treatment were welcomed by many, but questions remain about how new norms and policy changes will be sustained beyond this pandemic and impact OUD treatment access and outcomes long-term.

Discussing non-invasive prenatal testing on Reddit: The benefits, the concerns, and the comradery

OBJECTIVE

As the use of non-invasive prenatal testing (NIPT) increases, its benefits and concerns are being examined through surveys, qualitative studies, and bioethical analysis. However, only scant research has examined public discourse on the topic. This research examined NIPT discussions on the social media platform Reddit.

METHOD

Content and qualitative description analysis was performed on 98 NIPT discussions (2682 comments), obtained by inputting "NIPT" into Reddit's search engine.

RESULTS

Detailing of benefits and concerns was found in collaborative and supportive discussions. Overall, NIPT is seen as valuable and desirable. Some concerns focused on cost-related barriers to access, anxiety related to testing, and interpretation of results. NIPT is often portrayed as offering peace of mind and is sometimes described as a means of preparing for possible outcomes.

CONCLUSION

In the discussions analyzed, NIPT is seen, overall, as valuable and greater access to it is desired. Some questions and concerns about NIPT were evident. Reddit stands as a valuable and appreciated tool for individuals wishing to discuss NIPT and to solicit and share information, opinions, and experiences. Health care providers should consider the ways social platforms such as Reddit can be engaged to better inform and educate the public.

Health and kinship matter: Learning about direct-to-consumer genetic testing user experiences via online discussions

Background

Millions of people have undergone direct-to-consumer genetic testing (DTC-GT), but little is known about individuals' motivations and experiences (e.g., discussion topics and emotions after obtaining the test results) in engaging with DTC-GT services. Previous studies either involved only a small number of DTC-GT consumers or were based on hypothetical scenarios.

Objective

Our study aimed to fill this gap by investigating online discussions about DTC-GT that developed naturally among tens of thousands of social media users.

Methods

We focused on the posts that were published in the r/23andme and r/AncestryDNA subreddits, which correspond to the two companies with the largest number of consumers in the DTC-GT market. We applied computational methods to infer and examine the topics discussed, temporal trends in posting rates and themes (e.g., aggregation of related topics), and emotions expressed in these online forums.

Results

We collected 157,000 posts published by 16,500 Reddit users between 2013 and 2019. We found that the posting rates increased sharply after popular promotional events (e.g., each Amazon Prime Day and Black Friday) and most posts were inquiries into, or status updates about, testing progress. The inferred themes of Ancestral Origin and Kinship/Feelings were the two most frequently discussed, while discussions about the Health Risks theme focused primarily on submitting DTC-GT raw data to third parties for interpretation. The Kinship/Feelings theme exhibited the largest range of emotional response. A qualitative review of the posts with extreme emotions showed that some people became excited because they found their biological parents or other kin, while others became upset because they unexpectedly found that their parents or other kin were not biologically related to them.

Conclusion

This research demonstrates that online social media platforms can serve as a rich resource for characterizing actual DTC-GT experiences. The findings suggest that DTC-GT consumers' purchasing behaviors are associated with societal events and that future investigations should consider how DTC-GT challenges our understanding of kinship structure and function, genomic privacy, and the interpretation of health risks.

Studying social media sentiment using human validated analysis

The measurement of online sentiment is a developing field in social science and big data research. The methodology from this study provides an analysis of online sentiment using a unique combination of NLP and human validation techniques in order to create net sentiment scores and categorise topics of online conversation. The study focused on measuring the online sentiment of South Africa's major banks (covering almost the entire retail banking industry) over a 12-month period. Through this methodology, firms are able to track shifts in online sentiment (including extreme firestorms) as well as to monitor relevant conversation topics. To date, no published methodology combines the use of big data NLP and human validation in such a structured way.•Microsampling for manual validation of sentiment analysis (both qualitative and quantitative approaches in order to obtain the most accurate results)•Sentiment measurement•Sentiment map.

The Direct and Indirect Effects of Online Social Support, Neuroticism, and Web Content Internalization on the Drive for Thinness among Women Visiting Health-Oriented Websites

One of the debates about media usage is the potential harmful effect that it has on body image and related eating disturbances because of its representations of the “ideal body”. This study focuses on the drive for thinness among the visitors of various health-oriented websites and online platforms because neither has yet been sufficiently studied in this context. Specifically, this study aims to bring more insight to the risk factors which can increase the drive for thinness in the users of these websites. We tested the presumption that web content internalization is a key factor in this process, and we considered the effects of selected individual factors, specifically the perceived online social support and neuroticism. We utilized survey data from 445 Czech women (aged 18–29, M = 23.5, SD = 3.1) who visited nutrition, weight loss, and exercise websites. The results showed a positive indirect link between both perceived online social support and neuroticism to the drive for thinness via web content internalization. The results are discussed with regard to the dual role of online support as both risk and protective factor. Moreover, we consider the practical implications for eating behavior and weight-related problems with regard to prevention and intervention.