JMIR Publications

ABSTRACT

Background:

The Morbidity and Mortality Weekly Report reported that polysubstance use (PU) 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 PU 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 utilized to derive insights into public opinions, sentiments, and clinical and public health policy implications.

Objective:

Based on perinatal polysubstance use (PPU) data we extracted on the X from May 1, 2019, to Oct. 31, 2021, we aim to address the following two primary research questions: 1. What is the overall trend and sentiment of PPU discussions on X? 2. Are there any distinct patterns in discussion trends of PPU-related tweets? If so, what are the implications for perinatal care and associated public health policies?

Methods:

We utilized X’s application programming interface (API) to extract over six million raw tweets globally, using keywords containing two or more prenatal health and substance-related keywords provided by our clinical team. In this exploratory study, after removing all non-English tweets, non-United States (US) tweets, and US tweets without disclosed geolocations, we obtained 4,848 PPU-related US tweets. Then we evaluated them using a mixed-method 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 Kappa score of 0.7748 for intercoder reliability.

Results:

From the quantitative analysis, we found the overall PPU trend, bigram, and trigram patterns, and negative sentiments were more dominant in PPU tweets (51.36%) than in the non-PPU sample (27.29%). The paired polysubstance use (85.27%) was the most common with a combination of “Alcohol and Drugs” identified as the most mentioned in PPU tweets. From the qualitative analysis, we identified three main themes in our PPU tweets, which include non-substance, single substance, and polysubstance. Through further thematic content analysis, we identified four 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 PPU in the vulnerable perinatal population with significant stigmas and legal ramifications discussed on X. Overall public sentiments on PPU were mixed with negative (51.36%), positive (39.86%), and neutral (8.78%). Among identified polysubstance combinations, “Alcohol and Drugs” become the driving substances in perinatal care. One important observation is that the normalization of PPU discussed on X is becoming more prevalent, and thus, this study provides valuable insights for clinicians and healthcare scholars to further understand the complexity of PPU technically and clinically, and implications for public health practitioners and policymakers to provide proper access and support to individuals with PPU for early PPU interventions and treatments.