Health-Related Concerns of Anti-LGBTQ+ Legislation: Thematic Analysis Using Social Media Data (Preprint)

BACKGROUND There has been a recent proliferation of anti-LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning) legislation being proposed in the United States, including more than 500 bills across 42 states in 2024. Many of the studies examining the impact of anti-LGBTQ+ legislation have focused specifically on the association with mental health outcomes. OBJECTIVE The objective of this study was to use social media data to more broadly explore health-related concerns of anti-LGBTQ+ legislation among sexual minority men in the United States. METHODS We leveraged a dataset containing 70 million tweets that were posted by 23,276 users in the United States who self-reported on Twitter that they are sexual minority men. First, we searched these tweets for keywords related to LGBTQ+ legislation. Next, we developed a codebook for identifying those that expressed health-related concerns of anti-LGBTQ+ legislation. Then, we developed a coding scheme to categorize these concerns into one or more themes by using an inductive approach. Finally, we automatically identified the users’ geographic location and age for subgroup analyses. RESULTS Among 8486 keyword-matched tweets, 493 (5.8%) tweets expressed health-related concerns due to anti-LGBTQ+ legislation and were posted by 288 sexual minority men in the United States: 112 (38.9%) who posted about health care, 84 (29.2%) about safety, 64 (22.2%) about mental health, 62 (21.5%) about general harm, 49 (17%) about human rights, and 40 (13.9%) about support. Health care was the top concern overall and across the United States and age groups. In contrast, the higher prevalence of mental health was driven by the larger number of users in the South, as it was less of a concern in other regions. Similarly, mental health was less of a concern among older age groups. Safety was as much of a concern as mental health overall and across the United States and most age groups. CONCLUSIONS Our findings may inform a broader range of health interventions and approaches for targeting them at specific populations of sexual minority men. By demonstrating that these concerns are expressed on social media, our findings can be leveraged by advocacy groups to amplify voices and rally public support for countering anti-LGBTQ+ bills.