Twitter-derived measures of sentiment towards minorities (2015–2016) and associations with low birth weight and preterm birth in the United States

INTRODUCTION: The objective of this study was to investigate the association between state-level publicly expressed sentiment towards racial and ethnic minorities and birth outcomes for mothers who gave birth in that state. METHODS: We utilized Twitter's Streaming Application Programming Interface (API) to collect 1,249,653 tweets containing at least one relevant keyword pertaining to a racial or ethnic minority group. State-level derived sentiment towards racial and ethnic minorities were merged with data on all 2015 U.S. births (N=3.99 million singleton births). RESULTS: Mothers living in states in the lowest tertile of positive sentiment towards racial/ethnic minorities had greater prevalences of low birth weight (+6%), very low birth weight (+9%), and preterm birth (+10%) compared to mothers living in states in the highest tertile of positive sentiment, controlling for individual-level maternal characteristics and state demographic characteristics. Sentiment towards specific racial/ethnic groups showed a similar pattern. Mothers living in states in the lowest tertile of positive sentiment towards blacks had an 8% greater prevalence of low birth weight and very low birth weight, and a 16% greater prevalence of preterm birth, compared to mothers living in states in the highest tertile. Lower state-level positive sentiment towards Middle Eastern groups was also associated with a 4-13% greater prevalence of adverse birth outcomes. Results from subgroup analyses restricted to racial/ethnic minority mothers did not differ substantially from those seen for the full population of mothers. CONCLUSIONS: More negative area-level sentiment towards blacks and Middle Eastern groups was related to worse individual birth outcomes, and this is true for the full population and minorities.