"This show hits really close to home on so many levels": An analysis of Reddit comments about HBO's Euphoria to understand viewers' experiences of and reactions to substance use and mental illness

Substance Use among School-Going Adolescents and Young Adults in Rural Mpumalanga Province, South Africa

The ongoing public health crisis of substance use among school adolescents and young adults (AYAs) in South Africa is not new in research parlance, amidst the national policy of drug abuse management in schools. In view of no tangible progress to reduce substance use in high schools in the country, we conducted a cross-sectional quantitative study aimed at investigating substance use among adolescents and young adults in the four public high schools selected through multi-stage sampling in rural Mpumalanga province, South Africa. Data on substance use, demographics, household socio-demographics, and related factors were collected via a validated self-administered questionnaire. Hierarchical logistic regression was performed using STATA 18. The study included 402 AYAs aged between 14 and 23 years (18 ± 1 years), and 45% reported substance use in the last twelve months. Alcohol was the most used substance (74%), followed by cigarettes (12%) and cannabis (11%). AYAs used substances out of social influence, curiosity, to find joy, and to eliminate stress, especially in social events, on the streets, and at home, and reported negative physical health outcomes, mainly hallucinations, sleeping disorders, body weakness, and dry mouths. Hierarchical logistic regression showed that the likelihood of substance use was three times in a particular high school (S4) (AOR = 3.93, 95%CI: 1.72-8.99), twice among the grade 12s (AOR = 2.73, 95%CI: 1.46-5.11), over twenty times in the communities with substance availability (AOR = 22.45, 95%CI: 2.75-183.56), almost ten times among AYAs participating in recreational/sports activities (AOR = 9.74, 95%CI: 4.21-22.52), and twice likely to happen in larger households (AOR = 2.96, 95%CI: 1.57-5.58). Prevention and intervention efforts should consider these specific health concerns to develop targeted strategies for mitigating substance use and its adverse consequences in this vulnerable population towards achieving the United Nations' Sustainable Development Goal Target 3.5, which aims to strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and the harmful use of alcohol.

First-hand accounts of structural stigma toward people who use opioids on Reddit

People who use opioids face multilevel stigma that negatively affects their health and well-being and drives opioid-related overdose. Little research has focused on lived experience of the structural levels of stigma toward opioid use. This study identified and qualitatively analyzed Reddit content about structural stigma toward opioid use. Iterative, human-in-the-loop natural language processing methods were used to identify relevant posts and comments from an opioid-related subforum. Ultimately, 273 posts and comments were qualitatively analyzed via directed content analysis guided by a prominent conceptualization of stigma. Redditors described how structures-including governmental programs and policies, the pharmaceutical industry, and healthcare systems-stigmatize people who use opioids. Structures were reported to stigmatize through labeling (i.e., particularly in medical settings), perpetuating negative stereotypes, separating people who use opioids into those who use opioids "legitimately" versus "illegitimately," and engendering status loss and discrimination (e.g., denial of healthcare, loss of employment). Redditors also posted robust formulations of structural stigma, mostly describing how it manifests in the criminalization of substance use, is often driven by profit motive, and leads to the pervasiveness of fentanyl in the drug supply and the current state of the overdose crisis. Some posts and comments highlighted interpersonal and structural resources (e.g., other people who use opioids, harm reduction programs, telemedicine) leveraged to navigate structural stigma and its effects. These findings reveal key ways by which structural stigma can pervade the lives of people who use opioids and show the value of social media data for investigating complex social processes. Particularly, this study's findings related to structural separation may help encourage efforts to promote solidarity among people who use opioids. Attending to first-hand accounts of structural stigma can help interventions aiming to reduce opioid-related stigma be more responsive to these stigmatizing structural forces and their felt effects.

Postpartum Extended-Release Buprenorphine Tissue Necrosis

BACKGROUND

Extended-release buprenorphine (XRB) may improve medication for opioid use disorder continuation among postpartum individuals. However, obstetric clinicians have relatively little experience with XRB. We describe two cases of XRB-related tissue necrosis in postpartum individuals to highlight recommended injection technique and management strategies for this rare complication.

CASES

One patient developed tissue necrosis after her initial injection. Her wound was expectantly managed. Another patient on long-term XRB developed tissue necrosis within 1 day of injection. General surgery excised the depot. Both instances were attributed to injection of XRB intradermally rather than subcutaneously. Both patients continued monthly XRB without recurrence, suggesting that this complication is not an allergy.

CONCLUSION

Clinicians should be able to prevent, recognize, and manage tissue necrosis, a rare complication of XRB injection.

Investigating Substance Use via Reddit: Systematic Scoping Review

BACKGROUND

Reddit's (Reddit Inc) large user base, diverse communities, and anonymity make it a useful platform for substance use research. Despite a growing body of literature on substance use on Reddit, challenges and limitations must be carefully considered. However, no systematic scoping review has been conducted on the use of Reddit as a data source for substance use research.

OBJECTIVE

This review aims to investigate the use of Reddit for studying substance use by examining previous studies' objectives, reasons, limitations, and methods for using Reddit. In addition, we discuss the implications and contributions of previous studies and identify gaps in the literature that require further attention.

METHODS

A total of 7 databases were searched using keyword combinations including Reddit and substance-related keywords in April 2022. The initial search resulted in 456 articles, and 227 articles remained after removing duplicates. All included studies were peer reviewed, empirical, available in full text, and pertinent to Reddit and substance use, and they were all written in English. After screening, 60 articles met the eligibility criteria for the review, with 57 articles identified from the initial database search and 3 from the ancestry search. A codebook was developed, and qualitative content analysis was performed to extract relevant evidence related to the research questions.

RESULTS

The use of Reddit for studying substance use has grown steadily since 2015, with a sharp increase in 2021. The primary objective was to identify tendencies and patterns in various types of substance use discussions (52/60, 87%). Reddit was also used to explore unique user experiences, propose methodologies, investigate user interactions, and develop interventions. A total of 9 reasons for using Reddit to study substance use were identified, such as the platform's anonymity, its widespread popularity, and the explicit topics of subreddits. However, 7 limitations were noted, including the platform's low representativeness of the general population with substance use and the lack of demographic information. Most studies use application programming interfaces for data collection and quantitative approaches for analysis, with few using qualitative approaches. Machine learning algorithms are commonly used for natural language processing tasks. The theoretical, methodological, and practical implications and contributions of the included articles are summarized and discussed. The most prevalent practical implications are investigating prevailing topics in Reddit discussions, providing recommendations for clinical practices and policies, and comparing Reddit discussions on substance use across various sources.

CONCLUSIONS

This systematic scoping review provides an overview of Reddit's use as a data source for substance use research. Although the limitations of Reddit data must be considered, analyzing them can be useful for understanding patterns and user experiences related to substance use. Our review also highlights gaps in the literature and suggests avenues for future research.

Characterizing the Influence of Television Health Entertainment Narratives in Lay Populations: A Scoping Review

OBJECTIVE

To conduct a scoping review of published literature examining the influence of health storylines from fictional television programs on viewers.

DATA SOURCE

We performed literature searches in Medline, PsycINFO, and Mass Media Complete in October 2021, and examined bibliographies of included articles and conducted forward searching using Web of Science with included articles.

STUDY INCLUSION AND EXCLUSION CRITERIA

Selected studies were required to be original research published in English, involve exposure to fictional television programming by individuals not in the medical field, and assess associations between exposure and health-related outcomes.

DATA EXTRACTION

Article screening and data abstraction were performed by two independent researchers using DistillerSR (Cohen's κ range: .73-1.00).

DATA SYNTHESIS

We analyzed and qualitatively described the data using methods of scoping reviews described by PRISMA-ScR.

RESULTS

Of 5,537 unique records identified, 165 met inclusion criteria. The most frequently studied program was ER (n = 22, 13.3%). Most studies had adult participants (n = 116, 70.3%) and used quantitative methods (n = 136, 82.4%). The most frequently examined health topics were sexual behavior (n = 28, 17.0%) and mental health (n = 28, 17.0%). Exposure had a positive influence on viewers' health-related outcomes in 28.5% (n = 47) of studies.

CONCLUSION

Health storylines on fictional television influence viewers. Future research could address gaps identified in this review to further elucidate the influence of this programming on health promotion and disease prevention.

Foreign pop-culture and backlash: the case of non-fan K-pop Subreddits during the pandemic

Communication research establishes that when confronted with information contradicting their beliefs, people tend to 'backlash' by doubling down on their prior. Can international popular culture be the context of backlash? This paper analyzes two K-pop Subreddits (r/WeHateKpop and r/Cringetopia) populated by non-fans. A particular focus is given to their attitudinal changes upon being exposed to news stories about South Korea. I argue that a heavy dose of positive news stories about South Korea triggers non-fans as they associate K-pop with the country. This exposure leads to backlash, resulting in increased engagement with the posts critical of K-pop in the two Subreddits. I present a series of econometric evidence strongly supportive of this argument. The paper is a rare large-N study on the non-fans of K-pop. It offers implications for cultural economics, demonstrating how seemingly irrelevant news stories can have profound effects on individuals' engagement with foreign cultures.

Topics and Sentiment Surrounding Vaping on Twitter and Reddit During the 2019 e-Cigarette and Vaping Use-Associated Lung Injury Outbreak: Comparative Study

BACKGROUND

Vaping or e-cigarette use has become dramatically more popular in the United States in recent years. e-Cigarette and vaping use-associated lung injury (EVALI) cases caused an increase in hospitalizations and deaths in 2019, and many instances were later linked to unregulated products. Previous literature has leveraged social media data for surveillance of health topics. Individuals are willing to share mental health experiences and other personal stories on social media platforms where they feel a sense of community, reduced stigma, and empowerment.

OBJECTIVE

This study aimed to compare vaping-related content on 2 popular social media platforms (ie, Twitter and Reddit) to explore the context surrounding vaping during the 2019 EVALI outbreak and to support the feasibility of using data from both social platforms to develop in-depth and intelligent vaping detection models on social media.

METHODS

Data were extracted from both Twitter (316,620 tweets) and Reddit (17,320 posts) from July 2019 to September 2019 at the peak of the EVALI crisis. High-throughput computational analyses (sentiment analysis and topic analysis) were conducted. In addition, in-depth manual content analyses were performed and compared with computational analyses of content on both platforms (577 tweets and 613 posts).

RESULTS

Vaping-related posts and unique users on Twitter and Reddit increased from July 2019 to September 2019, with the average post per user increasing from 1.68 to 1.81 on Twitter and 1.19 to 1.21 on Reddit. Computational analyses found the number of positive sentiment posts to be higher on Reddit (P<.001, 95% CI 0.4305-0.4475) and the number of negative posts to be higher on Twitter (P<.001, 95% CI -0.4289 to -0.4111). These results were consistent with the clinical content analyses results indicating that negative sentiment posts were higher on Twitter (273/577, 47.3%) than Reddit (184/613, 30%). Furthermore, topics prevalent on both platforms by keywords and based on manual post reviews included mentions of youth, marketing or regulation, marijuana, and interest in quitting.

CONCLUSIONS

Post content and trending topics overlapped on both Twitter and Reddit during the EVALI period in 2019. However, crucial differences in user type and content keywords were also found, including more frequent mentions of health-related keywords on Twitter and more negative health outcomes from vaping mentioned on both Reddit and Twitter. Use of both computational and clinical content analyses is critical to not only identify signals of public health trends among vaping-related social media content but also to provide context for vaping risks and behaviors. By leveraging the strengths of both Twitter and Reddit as publicly available data sources, this research may provide technical and clinical insights to inform automatic detection of social media users who are vaping and may benefit from digital intervention and proactive outreach strategies on these platforms.

The Historical Significance of Titicut Follies in Psychiatric Treatment: An Anti-Censorship Perspective

Works of art and information judged as obscene can be censored or banned. This brief review evaluates the costs and benefits of censorship and the banning of artwork and information. In the history of psychology, Frederick Wiseman's film Titicut Follies epitomizes the disadvantages of concealing art content. Despite protecting the privacy of patients, the ban of Titicut Follies delayed the reform of psychiatric treatment practices and hospitals. The decision to censor or ban artistic and scientific information can result in the loss of knowledge and potential improvements to social, political, and economic institution practices.

Types and Sources of Stigma on Opioid Use Treatment and Recovery Communities on Reddit

Background: Digitally-mediated peer support may improve opioid use disorder (OUD) recovery. Our objective was to examine the types and sources of stigma that people seek support for in online OUD recovery communities (subreddits) on Reddit. Methods: We extracted all posts containing stigma keywords from three subreddits as well as a random sample that do not contain stigma keywords. We conducted deductive content analysis to confirm that the post self-described an experience of stigma and identify the type (condition, intervention) and source (provider-based, public, self, structural) of stigma. Results: Two-hundred and fifty-nine posts self-reported a stigmatizing experience. The majority of posts described an intervention stigma associated with medications for OUD. Posts discussing intervention stigma acknowledged the role of stigma in their treatment decision-making and quality of their treatment program. The most frequent sources of stigma were the public (including family members), provider-based (healthcare and pharmacy workers), structural (workplace, law enforcement, child protective services, and abstinence-based self-help groups), and self. No posts mentioned courtesy stigma. Posts sought assistance in navigating their experiences and participating in advocacy to counter stigmatized narratives. Conclusions: Our study indicates that people in online communities seek support to disclose and manage experiences of stigma on Reddit in similar ways to people in offline communities with the noted exception of an absence of discussions of courtesy stigma. Since each subreddit is a microcosm of varying needs, we suggest areas of future work for collaborative resources developed between stakeholders of these subreddits and public health that work within the preexisting Reddit social norms.

Fact-Checking of Health Information: The Effect of Media Literacy, Metacognition and Health Information Exposure

With the rampant circulation of health information, concerns for the information quality are growing. Thereby, scholars are calling for media literacy as an educative means to cultivate fact-checking behavior among information consumers. Focusing on the critical role of metacognition for education effectiveness, this study examined the underlying mechanism that is conducive to the success of media literacy in the context of health information consumption. Based on the survey data collected from 502 Reddit.com users, our findings showed that media literacy was positively associated with fact-checking behavior for health information. Mediation analysis indicated that metacognition mediated the positive relationship between media literacy and fact-checking behavior. In addition, moderated-mediation analysis demonstrated that the mediating effect was weaker for individuals who had higher exposure to health information. The study sheds light on the factors that are essential for the success of media literacy. Implications and future directions are discussed.