Robert G. Brookshire

Background: According to the Morbidity and Mortality Weekly Report, polysubstance use among pregnant women is prevalent, with 38.2% of those who consume alcohol also engaging in the use of one or more additional substances. However, the underlying mechanisms, contexts, and experiences of polysubstance use are unclear. Organic information is abundant on social media such as X (formerly Twitter). Traditional quantitative and qualitative methods, as well as natural language processing techniques, can be jointly used to derive insights into public opinions, sentiments, and clinical and public health policy implications. Objective: Based on perinatal polysubstance use (PPU) data that we extracted on X from May 1, 2019, to October 31, 2021, we proposed two primary research questions: (1) What is the overall trend and sentiment of PPU discussions on X? (2) Are there any distinct patterns in the discussion trends of PPU-related tweets? If so, what are the implications for perinatal care and associated public health policies? Methods: We used X’s application programming interface to extract >6 million raw tweets worldwide containing ≥2 prenatal health- and substance-related keywords provided by our clinical team. After removing all non–English-language tweets, non-US tweets, and US tweets without disclosed geolocations, we obtained 4848 PPU-related US tweets. We then evaluated them using a mixed methods approach. The quantitative analysis applied frequency, trend analysis, and several natural language processing techniques such as sentiment analysis to derive statistics to preview the corpus. To further understand semantics and clinical insights among these tweets, we conducted an in-depth thematic content analysis with a random sample of 500 PPU-related tweets with a satisfying κ score of 0.7748 for intercoder reliability. Results: Our quantitative analysis indicates the overall trends, bigram and trigram patterns, and negative sentiments were more dominant in PPU tweets (2490/4848, 51.36%) than in the non-PPU sample (1323/4848, 27.29%). Paired polysubstance use (4134/4848, 85.27%) was the most common, with the combination alcohol and drugs identified as the most mentioned. From the qualitative analysis, we identified 3 main themes: nonsubstance, single substance, and polysubstance, and 4 subthemes to contextualize the rationale of underlying PPU behaviors: lifestyle, perceptions of others’ drug use, legal implications, and public health. Conclusions: This study identified underexplored, emerging, and important topics related to perinatal PPU, with significant stigmas and legal ramifications discussed on X. Overall, public sentiments on PPU were mixed, encompassing negative (2490/4848, 51.36%), positive (1884/4848, 38.86%), and neutral (474/4848, 9.78%) sentiments. The leading substances in PPU were alcohol and drugs, and the normalization of PPU discussed on X is becoming more prevalent. Thus, this study provides valuable insights to further understand the complexity of PPU and its implications for public health practitioners and policy makers to provide proper access and support to individuals with PPU.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: According to the Morbidity and Mortality Weekly Report, polysubstance use among pregnant women is prevalent, with 38.2% of those who consume alcohol also engaging in the use of one or more additional substances. However, the underlying mechanisms, contexts, and experiences of polysubstance use are unclear. Organic information is abundant on social media such as X (formerly Twitter). Traditional quantitative and qualitative methods, as well as natural language processing techniques, can be jointly used to derive insights into public opinions, sentiments, and clinical and public health policy implications. Objective: Based on perinatal polysubstance use (PPU) data that we extracted on X from May 1, 2019, to October 31, 2021, we proposed two primary research questions: (1) What is the overall trend and sentiment of PPU discussions on X? (2) Are there any distinct patterns in the discussion trends of PPU-related tweets? If so, what are the implications for perinatal care and associated public health policies? Methods: We used X’s application programming interface to extract >6 million raw tweets worldwide containing ≥2 prenatal health- and substance-related keywords provided by our clinical team. After removing all non–English-language tweets, non-US tweets, and US tweets without disclosed geolocations, we obtained 4848 PPU-related US tweets. We then evaluated them using a mixed methods approach. The quantitative analysis applied frequency, trend analysis, and several natural language processing techniques such as sentiment analysis to derive statistics to preview the corpus. To further understand semantics and clinical insights among these tweets, we conducted an in-depth thematic content analysis with a random sample of 500 PPU-related tweets with a satisfying κ score of 0.7748 for intercoder reliability. Results: Our quantitative analysis indicates the overall trends, bigram and trigram patterns, and negative sentiments were more dominant in PPU tweets (2490/4848, 51.36%) than in the non-PPU sample (1323/4848, 27.29%). Paired polysubstance use (4134/4848, 85.27%) was the most common, with the combination alcohol and drugs identified as the most mentioned. From the qualitative analysis, we identified 3 main themes: nonsubstance, single substance, and polysubstance, and 4 subthemes to contextualize the rationale of underlying PPU behaviors: lifestyle, perceptions of others’ drug use, legal implications, and public health. Conclusions: This study identified underexplored, emerging, and important topics related to perinatal PPU, with significant stigmas and legal ramifications discussed on X. Overall, public sentiments on PPU were mixed, encompassing negative (2490/4848, 51.36%), positive (1884/4848, 38.86%), and neutral (474/4848, 9.78%) sentiments. The leading substances in PPU were alcohol and drugs, and the normalization of PPU discussed on X is becoming more prevalent. Thus, this study provides valuable insights to further understand the complexity of PPU and its implications for public health practitioners and policy makers to provide proper access and support to individuals with PPU.

BACKGROUND During the COVID-19 pandemic, it is of vital importance to identify factors that promote behavioral compliance of consumers to the recommendations of government agencies. OBJECTIVE This study analyzed demographic characteristics, acquired knowledge, and personal beliefs, in combination with anxiety and stress, as indicators of compliance in the general population to recommended behavioral changes during COVID-19. METHODS Data from a survey that was administered on Facebook, Instagram, Twitter, and WhatsApp was analyzed. Participation was voluntary and no compensation of any kind was provided. T tests and analysis of variance were used to compare average scores of the different demographic groups, with degrees of freedom adjusted if the equal variance assumption appeared to be violated. Logistic regression was used to determine the odds ratios for adoption of the various preventive behaviors. Data were analyzed using SPSS (version 27, IBM Corp). Structural equation modelling was performed using SmartPLS. The impact of personal characteristics – age, gender, education, race, and political affiliation, combined with acquired knowledge about COVID-19, personal beliefs during the crisis, and the resulting anxiety and stress were evaluated for their effect on the adoption of recommended behavioral changes during COVID-19. RESULTS 5,677 social media users participated in the online survey, however, only 4,998 completed the entire survey and were used in our analyses. Only respondents who were 18 years of age or older and U.S. residents were included in the final data set. Females had a higher average knowledge about COVID-19 (t=3.09, df=4960, p<0.01), but the genders were similar in their knowledge of protective factors (t=0.26, df=4960, p=0.79). Republicans had a lower average COVID-19 knowledge score (t=-3.93, df=4996, p<0.001) and a lower average knowledge of protective factors (t=-2.82, df=4996, p<0.01). Those with higher levels of education had higher mean COVID-19 knowledge scores (F=79.10, df=4,4993, p<0.001). Among the different age groups, younger respondents had higher levels of COVID-19 knowledge (F=11.46, df=2,4995, p<0.001), but the age groups were similar in their knowledge of protective factors (F=0.28, df=2,4995, p=0.645). About two-thirds of the sample (67%) disagreed or strongly disagreed that COVID-19 was an act of bioterrorism. About 82% agreed or strongly agreed that COVID-19 is more deadly than the seasonal flu. About 84% agreed or strongly agreed that the amount of media attention paid to COVID-19 was adequate, and most (80%) disagreed or strongly disagreed that COVID-19 is not as big a problem as the media suggests. Republicans on average had higher agreement that the virus was released as an act of bioterrorism (t=16.00, df=2030.3, p<0.001), that the virus is not as big a problem as the media suggests (t=20.61, df=1908.3, p<0.001), and that warm weather will reduce the spread of the virus (t=16.52, df=2286, p<0.001). Among the preventive behaviors that respondents reported adopting, the most frequent were keeping away from crowded places (N=4863, 96.5%), using hand sanitizer or washing hands more often (N=4826, 95.8%), starting to clean or disinfect things they might touch (N=4482, 89.0%) and avoiding public transportation (N=4393, 87.2%). CONCLUSIONS Individual beliefs in the severity of the pandemic, the level of stress/anxiety, and protective knowledge for COVID-19 were significant indicators in the adoption of protective behaviors while the level of COVID-19 knowledge was weakly and negatively associated with these indicators. Demographic factors including age, gender, political affiliation, education level, and race were also significant indicators of behavioral compliance. Study findings can provide valuable insights that can be used to further increase behavioral compliance among the population during COVID-19.

Background: Patient education delivered by a health care provider increases patients’ understanding and adherence to medical instructions, which helps to improve patient health. Multiple challenges exist to delivering effective patient education to patients with multiple chronic conditions, including giving the necessary time, range, and types of learning materials, and assessing the level of understanding. To help overcome these challenges, it is important to study new electronic means to assist in patient education, such as the use of mobile devices, interactive media, 3-dimensional images, and multimedia educational content at the bedside. Objective: The goal of this study was to address the need for blended learning strategies combining technical and workflow integration of digital patient education systems for patients with chronic conditions within and across the regular process of care. Studies are needed to evaluate the utility and benefits of these technologies for providers and patients alike. Methods: A mixed-methods approach was employed including survey administration to 178 patients after they received digital patient education in person with a health care provider, and qualitative interviews with 16 nurse educators who used the mobile digital health education technology to deliver instruction to patients. Patient survey data were analyzed using chi-square statistical tests. Qualitative interviews were analyzed for user acceptance and perceived value themes. Results: Patients who were counseled using a blended digital health education approach reported improved understanding of educational content (P=.034) and chronic health conditions (P<.001), were more motivated to care for themselves at home (P<.001), were more likely to say that they felt capable of making health care decisions with their doctors (P<.001) and on their own (P=.001), and were more likely to report their intention to follow their doctor’s instructions (P<.001) than were patients whose education was not computer-based. Nurse educators felt that the digital education system and content enhanced their education efforts and could be easily integrated into the outpatient clinical workflow. Conclusions: Patient education for individuals with chronic conditions may be more effective than traditional formats when provided in blended digital formats supervised by a health care provider.

BACKGROUND Patient education delivered by a health care provider increases patients’ understanding and adherence to medical instructions, which helps to improve patient health. Multiple challenges exist to delivering effective patient education to patients with multiple chronic conditions, including giving the necessary time, range, and types of learning materials, and assessing the level of understanding. To help overcome these challenges, it is important to study new electronic means to assist in patient education, such as the use of mobile devices, interactive media, 3-dimensional images, and multimedia educational content at the bedside. OBJECTIVE The goal of this study was to address the need for blended learning strategies combining technical and workflow integration of digital patient education systems for patients with chronic conditions within and across the regular process of care. Studies are needed to evaluate the utility and benefits of these technologies for providers and patients alike. METHODS A mixed-methods approach was employed including survey administration to 178 patients after they received digital patient education in person with a health care provider, and qualitative interviews with 16 nurse educators who used the mobile digital health education technology to deliver instruction to patients. Patient survey data were analyzed using chi-square statistical tests. Qualitative interviews were analyzed for user acceptance and perceived value themes. RESULTS Patients who were counseled using a blended digital health education approach reported improved understanding of educational content (P=.034) and chronic health conditions (P<.001), were more motivated to care for themselves at home (P<.001), were more likely to say that they felt capable of making health care decisions with their doctors (P<.001) and on their own (P=.001), and were more likely to report their intention to follow their doctor’s instructions (P<.001) than were patients whose education was not computer-based. Nurse educators felt that the digital education system and content enhanced their education efforts and could be easily integrated into the outpatient clinical workflow. CONCLUSIONS Patient education for individuals with chronic conditions may be more effective than traditional formats when provided in blended digital formats supervised by a health care provider.

Students at a large southeastern university typically find the introductory networking and telecommunications course difficult. This study examines the