{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:49:16Z","timestamp":1782845356142,"version":"3.54.5"},"reference-count":73,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Large racial and ethnic disparities in adverse birth outcomes persist. Increasing evidence points to the potential role of racism in creating and perpetuating these disparities. Valid measures of area-level racial attitudes and bias remain elusive, but capture an important and underexplored form of racism that may help explain these disparities. Cultural values and attitudes expressed through social media reflect and shape public norms and subsequent behaviors. Few studies have quantified attitudes toward different racial groups using social media with the aim of examining associations with birth outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We used Twitter data to measure state-level racial sentiments and investigate associations with preterm birth (PTB) and low birth weight (LBW) in a multiracial or ethnic sample of mothers in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A random 1% sample of publicly available tweets from January 1, 2011, to December 31, 2021, was collected using Twitter\u2019s Academic Application Programming Interface (N=56,400,097). Analyses were on English-language tweets from the United States that used one or more race-related keywords. We assessed the sentiment of each tweet using support vector machine, a supervised machine learning model. We used 5-fold cross-validation to assess model performance and achieved high accuracy for negative sentiment classification (91%) and a high F1 score (84%). For each year, the state-level racial sentiment was merged with birth data during that year (~3 million births per year). We estimated incidence ratios for LBW and PTB using log binomial regression models, among all mothers, Black mothers, racially minoritized mothers (Asian, Black, or Latina mothers), and White mothers. Models were controlled for individual-level maternal characteristics and state-level demographics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mothers living in states in the highest tertile of negative racial sentiment for tweets referencing racial and ethnic minoritized groups had an 8% higher (95% CI 3%-13%) incidence of LBW and 5% higher (95% CI 0%-11%) incidence of PTB compared to mothers living in the lowest tertile. Negative racial sentiment referencing racially minoritized groups was associated with adverse birth outcomes in the total population, among minoritized mothers, and White mothers. Black mothers living in states in the highest tertile of negative Black sentiment had 6% (95% CI 1%-11%) and 7% (95% CI 2%-13%) higher incidence of LBW and PTB, respectively, compared to mothers living in the lowest tertile. Negative Latinx sentiment was associated with a 6% (95% CI 1%-11%) and 3% (95% CI 0%-6%) higher incidence of LBW and PTB among Latina mothers, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Twitter-derived negative state-level racial sentiment toward racially minoritized groups was associated with a higher risk of adverse birth outcomes among the total population and racially minoritized groups. Policies and supports establishing an inclusive environment accepting of all races and cultures may decrease the overall risk of adverse birth outcomes and reduce racial birth outcome disparities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/44990","type":"journal-article","created":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T11:02:16Z","timestamp":1682679736000},"page":"e44990","source":"Crossref","is-referenced-by-count":5,"title":["Examining Twitter-Derived Negative Racial Sentiment as Indicators of Cultural Racism: Observational Associations With Preterm Birth and Low Birth Weight Among a Multiracial Sample of Mothers, 2011-2021"],"prefix":"10.2196","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1185-045X","authenticated-orcid":false,"given":"Thu T","family":"Nguyen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4315-6211","authenticated-orcid":false,"given":"Junaid S","family":"Merchant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2470-5377","authenticated-orcid":false,"given":"Shaniece","family":"Criss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0132-5512","authenticated-orcid":false,"given":"Katrina","family":"Makres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5553-9818","authenticated-orcid":false,"given":"Krishik N","family":"Gowda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8859-3282","authenticated-orcid":false,"given":"Heran","family":"Mane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5922-1949","authenticated-orcid":false,"given":"Xiaohe","family":"Yue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3203-1322","authenticated-orcid":false,"given":"Yulin","family":"Hswen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9644-3081","authenticated-orcid":false,"given":"M Maria","family":"Glymour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4745-6681","authenticated-orcid":false,"given":"Quynh C","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5882-1026","authenticated-orcid":false,"given":"Amani M","family":"Allen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2023,4,28]]},"reference":[{"issue":"27","key":"ref1","first-page":"589","volume":"51","year":"2002","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref2","year":"2000","journal-title":"Healthy People 2010: Understanding and Improving Health"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph10062296"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/s0022-3476(05)83290-1"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60136-1"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1126\/science.296.5576.2167"},{"key":"ref7","unstructured":"ArtigaSPhamOOrgeraKRanjiURacial disparities in maternal and infant health: an overview - issue briefKFF20202022-09-16https:\/\/www.kff.org\/report-section\/racial-disparities-in-maternal-and-infant-health-an-overview-issue-brief\/"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2019.02.007"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-018-2500-7"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1111\/jmwh.12490"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1037\/0278-6133.27.2.194"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.90.8.1212"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1111\/josi.12350"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2020.3510"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1007\/s11673-020-10073-0"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30569-X"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-040218-043750"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyl056"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.131.5.662"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1023\/a:1011353216619"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1196\/annals.1391.028"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-022-00665-z"},{"issue":"54","key":"ref23","first-page":"129","author":"Rodat, S","year":"2017","journal-title":"Revista de \u0218tiin\u021be Politice\/ Revue des Sciences Politiques"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1177\/00027162211005690"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1177\/1948550617728995"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1006\/jesp.2000.1470"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1037\/hea0001141"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.84.4.738"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.soc.32.061604.123132"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1504\/IJBHR.2011.043414"},{"key":"ref31","unstructured":"OdabasM10 facts about Americans and TwitterPew Research Center20222022-11-26https:\/\/www.pewresearch.org\/fact-tank\/2022\/05\/05\/10-facts-about-americans-and-twitter\/"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-psych-122216-011911"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1057\/s41599-022-01268-4"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.2196\/17103"},{"key":"ref35","unstructured":"BartlettJReffinJRumballNWilliamsonSAnti-social mediaDEMOS20142023-02-03http:\/\/www.demos.co.uk\/files\/DEMOS_Anti-social_Media.pdf"},{"key":"ref36","unstructured":"The Racial Slur Database2023-02-03http:\/\/www.rsdb.org\/"},{"key":"ref37","unstructured":"GoABhayaniRHuangLTwitter sentiment classification using distant supervisionSentiment14020092022-11-28http:\/\/help.sentiment140.com\/home"},{"key":"ref38","unstructured":"UMICH SI650 - sentiment classificationKaggle20182022-11-26https:\/\/kaggle.com\/competitions\/si650winter11"},{"key":"ref39","unstructured":"SandersNTwitter sentiment corpusSanders Analytics20112022-11-26https:\/\/github.com\/zfz\/twitter_corpus"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1109\/mcse.2007.55"},{"key":"ref41","unstructured":"Tweet metadata timelineTwitter Developer Platform2023-03-13https:\/\/developer.twitter.com\/en\/docs\/twitter-api\/enterprise\/data-dictionary\/tweet-timeline"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000275264.78506.63"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006-1824"},{"key":"ref44","author":"DeVellis, RF","year":"2021","journal-title":"Scale Development : Theory and Applications"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/26.5.1071"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.2196\/publichealth.5869"},{"key":"ref47","unstructured":"American community survey (ACS)US Census Bureau2022-11-26https:\/\/www.census.gov\/programs-surveys\/acs"},{"key":"ref48","unstructured":"StataCorp LLCStata2022-11-26https:\/\/www.stata.com\/company\/"},{"key":"ref49","author":"McGhee, H","year":"2022","journal-title":"The Sum of Us : What Racism Costs Everyone and How We Can Prosper Together"},{"key":"ref50","unstructured":"AkalaACost Of racism: U.S. economy lost $16 trillion because of discrimination, bank saysNPR20202022-11-03https:\/\/tinyurl.com\/2s3th4ye"},{"key":"ref51","unstructured":"BoylePRacial resentment hurts White people too, physician tells colleaguesAAMC20222022-11-26https:\/\/www.aamc.org\/news-insights\/racial-resentment-hurts-white-people-too-physician-tells-colleagues"},{"key":"ref52","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-5907.2011.00577.x"},{"key":"ref53","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2011.300152"},{"key":"ref54","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2018.04.005"},{"key":"ref55","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2014.1052278"},{"key":"ref56","doi-asserted-by":"publisher","DOI":"10.18865\/ed.28.S1.231"},{"key":"ref57","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2021.100922"},{"key":"ref58","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17197032"},{"key":"ref59","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.952069"},{"key":"ref60","doi-asserted-by":"publisher","DOI":"10.1007\/s42761-021-00046-w"},{"key":"ref61","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2017.04.019"},{"key":"ref62","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0122963"},{"key":"ref63","doi-asserted-by":"publisher","DOI":"10.3390\/su142013094"},{"key":"ref64","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2021.100750"},{"key":"ref65","unstructured":"WojcikSHughesASizing up Twitter usersPew Research Center2023-03-13https:\/\/www.pewresearch.org\/internet\/2019\/04\/24\/sizing-up-twitter-users\/"},{"key":"ref66","unstructured":"AuxierBAndersonMSocial Media Use in 2021Pew Research Center20212022-11-28https:\/\/www.pewresearch.org\/internet\/2021\/04\/07\/social-media-use-in-2021\/"},{"key":"ref67","unstructured":"Population distribution by ageKFF20222022-11-28https:\/\/www.kff.org\/other\/state-indicator\/distribution-by-age\/"},{"key":"ref68","unstructured":"GreenwoodSPerrinADugganMSocial media update 2016Pew Research Center20162022-11-28https:\/\/www.pewresearch.org\/internet\/2016\/11\/11\/social-media-update-2016\/"},{"key":"ref69","unstructured":"Annual social and economic supplementsUS Census Bureau20212022-11-28https:\/\/www.census.gov\/data\/datasets\/time-series\/demo\/cps\/cps-asec.html"},{"key":"ref70","unstructured":"GuthMArtigaSMedicaid and racial health equityKFF20222022-11-26https:\/\/www.kff.org\/medicaid\/issue-brief\/medicaid-and-racial-health-equity\/"},{"key":"ref71","unstructured":"Cross-CallJMedicaid expansion has helped narrow racial disparities in health coverage and access to careCenter on Budget and Policy Priorities20202022-11-26https:\/\/www.cbpp.org\/research\/health\/medicaid-expansion-has-helped-narrow-racial-disparities-in-health-coverage-and"},{"key":"ref72","unstructured":"Preparing for the applicationTwitter Developer Platform2023-04-20https:\/\/developer.twitter.com\/en\/products\/twitter-api\/academic-research\/application-info"},{"key":"ref73","unstructured":"Restricted-use vital statistics dataCenters for Disease Control and Prevention2023-04-20https:\/\/www.cdc.gov\/nchs\/nvss\/nvss-restricted-data.htm"}],"container-title":["Journal of Medical Internet Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jmir.org\/2023\/1\/e44990","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:49:55Z","timestamp":1782841795000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jmir.org\/2023\/1\/e44990"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,28]]},"references-count":73,"URL":"https:\/\/doi.org\/10.2196\/44990","relation":{"has-preprint":[{"id-type":"doi","id":"10.2196\/preprints.44990","asserted-by":"object"}]},"ISSN":["1438-8871"],"issn-type":[{"value":"1438-8871","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,28]]}}}