{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T07:48:35Z","timestamp":1791532115297,"version":"4.3.4"},"reference-count":74,"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>Toxicity on social media, encompassing behaviors such as harassment, bullying, hate speech, and the dissemination of misinformation, has become a pressing social concern in the digital age. Its prevalence intensifies during periods of social crises and unrest, eroding a sense of safety and community. Such toxic environments can adversely impact the mental well-being of those exposed and further deepen societal divisions and polarization. The 2022 mpox outbreak, initially called \u201cmonkeypox\u201d but later renamed to reduce stigma and address societal concerns, provides a relevant context for this issue.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>In this study, we conducted a comprehensive analysis of the toxic online discourse surrounding the 2022 mpox outbreak. We aimed to dissect its origins, characterize its nature and content, trace its dissemination patterns, and assess its broader societal implications, with the goal of providing insights that can inform strategies to mitigate such toxicity in future crises.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We collected &gt;1.6 million unique tweets and analyzed them with 5 dimensions: context, extent, content, speaker, and intent. Using topic modeling based on bidirectional encoder representations from transformers and social network community clustering, we delineated the toxic dynamics on Twitter.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>By categorizing topics, we identified 5 high-level categories in the toxic online discourse on Twitter, including disease (20,281\/43,521, 46.6%), health policy and health care (8400\/43,521, 19.3%), homophobia (10,402\/43,521, 23.9%), politics (2611\/43,521, 6%), and racism (1784\/43,521, 4.1%). Across these categories, users displayed negativity or controversial views on the mpox outbreak, highlighting the escalating political tensions and the weaponization of stigma during this infodemic. Through the toxicity diffusion networks of mentions (17,437 vertices with 3628 clusters), retweets (59,749 vertices with 3015 clusters), and the top users with the highest in-degree centrality, we found that retweets of toxic content were widespread, while influential users rarely engaged with or countered this toxicity through retweets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study introduces a comprehensive workflow that combines topical and network analyses to decode emerging social issues during crises. By tracking topical dynamics, we can track the changing popularity of toxic content on the internet, providing a better understanding of societal challenges. Network dynamics highlight key social media influencers and their intentions, suggesting that engaging with these central figures in toxic discourse can improve crisis communication and guide policy making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/52997","type":"journal-article","created":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T14:30:35Z","timestamp":1734013835000},"page":"e52997","source":"Crossref","is-referenced-by-count":15,"title":["Toxicity on Social Media During the 2022 Mpox Public Health Emergency: Quantitative Study of Topical and Network Dynamics"],"prefix":"10.2196","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7962-9113","authenticated-orcid":false,"given":"Lizhou","family":"Fan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5888-8311","authenticated-orcid":false,"given":"Lingyao","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3793-7281","authenticated-orcid":false,"given":"Libby","family":"Hemphill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2024,12,12]]},"reference":[{"key":"ref1","unstructured":"PosnerLTurilliIMonkeypox timeline: a frequently updated tracker of emerging developments from the beginning of the 2022 monkeypox outbreakThink Global Health2023-09-07https:\/\/www.thinkglobalhealth.org\/article\/monkeypox-timeline"},{"key":"ref2","unstructured":"Mpox (monkeypox)World Health Organization (WHO)2023-09-06https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/monkeypox"},{"key":"ref3","unstructured":"WHO recommends new name for monkeypox diseaseWorld Health Organization (WHO)2023-09-06https:\/\/www.who.int\/news\/item\/28-11-2022-who-recommends-new-name-for-monkeypox-disease"},{"key":"ref4","unstructured":"Factsheet for health professionals on mpox (monkeypox)European Centre for Disease Prevention and Control2023-09-06https:\/\/www.ecdc.europa.eu\/en\/all-topics-z\/monkeypox\/factsheet-health-professionals"},{"key":"ref5","unstructured":"FDA Mpox responseU.S. Department of Food and Agriculture2023-09-06https:\/\/www.fda.gov\/emergency-preparedness-and-response\/mcm-issues\/fda-mpox-response"},{"key":"ref6","unstructured":"HHS response to the Mpox outbreakAssistant Secretary for Public Affairs (ASPA), U.S. Department of Health and Human Services2023-09-06https:\/\/www.hhs.gov\/mpox\/index.html"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.2196\/43841"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1007\/s41701-019-00065-w"},{"key":"ref9","unstructured":"Using machine learning to reduce toxicity onlinePerspective2023-09-06https:\/\/perspectiveapi.com"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1177\/20539517211046181"},{"key":"ref11","unstructured":"TurnerAHow many users does X (formerly Twitter) have?Bankmycell20232023-09-21https:\/\/www.bankmycell.com\/blog\/how-many-users-does-twitter-have"},{"key":"ref12","unstructured":"The Rabat plan of actionUnited Nations Human Rights2023-09-06https:\/\/www.ohchr.org\/en\/documents\/outcome-documents\/rabat-plan-action"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.neucom.2021.11.095"},{"key":"ref14","unstructured":"TDL brief: online toxicityThe Decision Lab2023-02-13https:\/\/thedecisionlab.com\/insights\/health\/tdl-brief-online-toxicity"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1089\/1094931041291295"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.chb.2020.106343"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1093\/joc\/jqab034"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1037\/men0000156"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-60975-7_31"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1177\/20563051221098343"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1145\/2818052.2869107"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1145\/3342220.3344933"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.2196\/19447"},{"key":"ref24","unstructured":"ModerationOpenAI2023-02-15https:\/\/platform.openai.com\/docs\/guides\/moderation\/overview"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1007\/s44204-022-00042-2"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0228723"},{"key":"ref27","first-page":"427","author":"Denecke, K","year":"2016","journal-title":"Participatory Health Through Social Media"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1080\/13669877.2017.1422787"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1017\/dmp.2015.31"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.2123"},{"key":"ref31","unstructured":"Maj\u00f3-V\u00e1zquezSNielsenRKVerd\u00faJRaoNDe DomenicoMPapaspiliopoulosOVolume and patterns of toxicity in social media conversations during the COVID-19 pandemicReuters Institute for the Study of Journalism2024-04-29https:\/\/reutersinstitute.politics.ox.ac.uk\/volume-and-patterns-toxicity-social-media-conversations-during-covid-19-pandemic"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1177\/20539517211023533"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1002\/wmh3.363"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30461-X"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.2196\/21820"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1080\/713851971"},{"key":"ref37","unstructured":"Twitter academic APITwitter2023-02-05https:\/\/developer.twitter.com\/en\/products\/twitter-api\/academic-research"},{"key":"ref38","unstructured":"BryantMPatient treated for monkeypox in isolation at London hospitalThe Guardian2023-09-06https:\/\/www.theguardian.com\/uk-news\/2022\/may\/07\/patient-treated-for-monkeypox-in-isolation-at-london-hospital"},{"key":"ref39","unstructured":"MathieuESpoonerFDattaniSRitchieHRoserMMpox (monkeypox)Our World in Data20222024-04-29https:\/\/ourworldindata.org\/monkeypox"},{"key":"ref40","unstructured":"HermannPPolice: assailants used slur and referenced monkeypox in Shaw attackThe Washington Post202208092023-09-07https:\/\/www.washingtonpost.com\/dc-md-va\/2022\/08\/09\/shaw-attack-monkeypox-slur-hate\/"},{"key":"ref41","unstructured":"KatesJArtigaSDawsonLNational data show continuing disparities in Monkeypox (MPX) cases and vaccinations among black and Hispanic peopleKaiser Family Foundation (KFF)2023-09-07https:\/\/www.kff.org\/racial-equity-and-health-policy\/issue-brief\/national-data-show-continuing-disparities-in-mpx-monkeypox-cases-and-vaccinations-among-black-and-hispanic-people\/"},{"key":"ref42","unstructured":"As Monkeypox eases in the West, \"nothing has changed\" for Africa, where doctors remain helplessCBS News2023-09-07https:\/\/www.cbsnews.com\/news\/monkeypox-vaccine-shortage-africa-as-virus-eases-in-us-europe\/"},{"key":"ref43","unstructured":"Toolkit for analysing a case of hate speechEuropean Court of Human Rights, The European Union2024-04-29https:\/\/rm.coe.int\/advanced-guide-toolkit-how-to-analyse-hate-speech\/1680a217cd"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1214\/07-aoas114"},{"key":"ref45","author":"Steyvers, M","year":"2007","journal-title":"Handbook of Latent Semantic Analysis"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1109\/irc.2018.00078"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-14783-5"},{"key":"ref48","doi-asserted-by":"publisher","DOI":"10.1007\/S10639-023-12256-9"},{"key":"ref49","author":"Vaswani, A","year":"2023","journal-title":"arXiv. Preprint posted online August 2, 2023"},{"key":"ref50","author":"Devlin, J","year":"2019","journal-title":"arXiv. Preprint posted online May 24, 2019"},{"key":"ref51","doi-asserted-by":"publisher","DOI":"10.18653\/v1\/2020.emnlp-main.135"},{"key":"ref52","author":"Grootendorst, M","year":"2022","journal-title":"arXiv. Preprint posted online March 11, 2022"},{"key":"ref53","doi-asserted-by":"publisher","DOI":"10.18653\/v1\/d19-1410"},{"key":"ref54","unstructured":"CuencaNRall-MiniLM-L6-v2Hugging Face2023-09-21https:\/\/huggingface.co\/sentence-transformers\/all-MiniLM-L6-v2"},{"key":"ref55","doi-asserted-by":"publisher","DOI":"10.21105\/joss.00861"},{"key":"ref56","doi-asserted-by":"publisher","DOI":"10.1145\/276698.276876"},{"key":"ref57","unstructured":"sklearn.cluster.KMeansScikit-learn2023-09-23https:\/\/scikit-learn.org\/stable\/modules\/generated\/sklearn.cluster.KMeans.html"},{"key":"ref58","doi-asserted-by":"publisher","DOI":"10.1016\/0146-664x(80)90054-4"},{"key":"ref59","unstructured":"FanLlizhouf\/mpox_50_topics_modelingHugging Face2023-09-21https:\/\/huggingface.co\/lizhouf\/mpox_50_topics_modeling"},{"key":"ref60","doi-asserted-by":"publisher","DOI":"10.1007\/S13042-010-0001-0"},{"key":"ref61","doi-asserted-by":"publisher","DOI":"10.2196\/42446"},{"key":"ref62","unstructured":"About different types of postsX (Formerly Twitter)2023-01-03https:\/\/help.twitter.com\/en\/using-twitter\/types-of-tweets"},{"key":"ref63","doi-asserted-by":"crossref","DOI":"10.4135\/9781412985864","author":"Knoke, D","year":"2008","journal-title":"Social Network Analysis"},{"key":"ref64","unstructured":"SmithMMilic-FraylingNShneidermanBMendesRELeskovecJDunneCNodeXL: a free and open network overview, discovery and exploration add-in for Excel 2007\/2010ScienceOpen20192024-04-29https:\/\/www.scienceopen.com\/document?vid=0b85110c-3853-4589-95cb-def966c20c49"},{"key":"ref65","doi-asserted-by":"publisher","DOI":"10.1103\/PhysRevE.70.066111"},{"key":"ref66","doi-asserted-by":"publisher","DOI":"10.1016\/j.ipm.2021.102660"},{"key":"ref67","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijinfomgt.2021.102397"},{"key":"ref68","doi-asserted-by":"publisher","DOI":"10.2196\/22609"},{"key":"ref69","doi-asserted-by":"publisher","DOI":"10.1109\/tcss.2023.3276764"},{"key":"ref70","doi-asserted-by":"publisher","DOI":"10.1080\/10494820.2022.2133145"},{"key":"ref71","author":"Awal, MR","year":"2020","journal-title":"arXiv. Preprint posted online July 21, 2020"},{"key":"ref72","doi-asserted-by":"publisher","DOI":"10.4135\/9781529604184"},{"key":"ref73","doi-asserted-by":"publisher","DOI":"10.1007\/s12103-020-09545-1"},{"key":"ref74","doi-asserted-by":"publisher","DOI":"10.1002\/pra2.313"}],"container-title":["Journal of Medical Internet Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jmir.org\/2024\/1\/e52997","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:38:15Z","timestamp":1782841095000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jmir.org\/2024\/1\/e52997"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,12]]},"references-count":74,"URL":"https:\/\/doi.org\/10.2196\/52997","relation":{},"ISSN":["1438-8871"],"issn-type":[{"value":"1438-8871","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,12]]}}}