title: "Mommy Blogs" and the Vaccination Exemption Narrative: Results From A Machine-Learning Approach for Story Aggregation on Parenting Social Media Sites.
abstract: BACKGROUND
  Social media offer an unprecedented opportunity to explore how people talk about health care at a very large scale. Numerous studies have shown the importance of websites with user forums for people seeking information related to health. Parents turn to some of these sites, colloquially referred to as "mommy blogs," to share concerns about children's health care, including vaccination. Although substantial work has considered the role of social media, particularly Twitter, in discussions of vaccination and other health care-related issues, there has been little work on describing the underlying structure of these discussions and the role of persuasive storytelling, particularly on sites with no limits on post length. Understanding the role of persuasive storytelling at Internet scale provides useful insight into how people discuss vaccinations, including exemption-seeking behavior, which has been tied to a recent diminution of herd immunity in some communities.
  
  
  OBJECTIVE
  To develop an automated and scalable machine-learning method for story aggregation on social media sites dedicated to discussions of parenting. We wanted to discover the aggregate narrative frameworks to which individuals, through their exchange of experiences and commentary, contribute over time in a particular topic domain. We also wanted to characterize temporal trends in these narrative frameworks on the sites over the study period.
  
  
  METHODS
  To ensure that our data capture long-term discussions and not short-term reactions to recent events, we developed a dataset of 1.99 million posts contributed by 40,056 users and viewed 20.12 million times indexed from 2 parenting sites over a period of 105 months. Using probabilistic methods, we determined the topics of discussion on these parenting sites. We developed a generative statistical-mechanical narrative model to automatically extract the underlying stories and story fragments from millions of posts. We aggregated the stories into an overarching narrative framework graph. In our model, stories were represented as network graphs with actants as nodes and their various relationships as edges. We estimated the latent stories circulating on these sites by modeling the posts as a sampling of the hidden narrative framework graph. Temporal trends were examined based on monthly user-poststatistics.
  
  
  RESULTS
  We discovered that discussions of exemption from vaccination requirements are highly represented. We found a strong narrative framework related to exemption seeking and a culture of distrust of government and medical institutions. Various posts reinforced part of the narrative framework graph in which parents, medical professionals, and religious institutions emerged as key nodes, and exemption seeking emerged as an important edge. In the aggregate story, parents used religion or belief to acquire exemptions to protect their children from vaccines that are required by schools or government institutions, but (allegedly) cause adverse reactions such as autism, pain, compromised immunity, and even death. Although parents joined and left the discussion forums over time, discussions and stories about exemptions were persistent and robust to these membership changes.
  
  
  CONCLUSIONS
  Analyzing parent forums about health care using an automated analytic approach, such as the one presented here, allows the detection of widespread narrative frameworks that structure and inform discussions. In most vaccination stories from the sites we analyzed, it is taken for granted that vaccines and not vaccine preventable diseases (VPDs) pose a threat to children. Because vaccines are seen as a threat, parents focus on sharing successful strategies for avoiding them, with exemption being the foremost among these strategies. When new parents join such sites, they may be exposed to this endemic narrative framework in the threads they read and to which they contribute, which may influence their health care decision making.
authors.affiliation: Center for Digital Humanities, University of California, Los Angeles, Los Angeles, CA, United States.
authors.forename: Timothy R
authors.identifier: http://orcid.org/0000-0002-1775-2052
authors.initials: TR
authors.lastname: Tangherlini
authors.affiliation: Department of Electrical Engineering, University of California, Los Angeles, Los Angeles, CA, United States.
authors.forename: Vwani
authors.identifier: http://orcid.org/0000-0003-0832-6489
authors.initials: V
authors.lastname: Roychowdhury
authors.affiliation: Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, Los Angeles, CA, United States.
authors.forename: Beth
authors.identifier: http://orcid.org/0000-0002-4937-8181
authors.initials: B
authors.lastname: Glenn
authors.affiliation: Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, Los Angeles, CA, United States.
authors.forename: Catherine M
authors.identifier: http://orcid.org/0000-0002-6150-2181
authors.initials: CM
authors.lastname: Crespi
authors.affiliation: Department of Electrical Engineering, University of California, Los Angeles, Los Angeles, CA, United States.
authors.forename: Roja
authors.identifier: http://orcid.org/0000-0002-8522-0904
authors.initials: R
authors.lastname: Bandari
authors.affiliation: Department of Electrical Engineering, University of California, Los Angeles, Los Angeles, CA, United States.
authors.forename: Akshay
authors.identifier: http://orcid.org/0000-0002-2792-1614
authors.initials: A
authors.lastname: Wadia
authors.affiliation: Department of Electrical Engineering, University of California, Los Angeles, Los Angeles, CA, United States.
authors.forename: Misagh
authors.identifier: http://orcid.org/0000-0002-4240-7664
authors.initials: M
authors.lastname: Falahi
authors.affiliation: Department of Electrical Engineering, University of California, Los Angeles, Los Angeles, CA, United States.
authors.forename: Ehsan
authors.identifier: http://orcid.org/0000-0002-7739-4197
authors.initials: E
authors.lastname: Ebrahimzadeh
authors.affiliation: Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, Los Angeles, CA, United States.
authors.forename: Roshan
authors.identifier: http://orcid.org/0000-0001-6594-9231
authors.initials: R
authors.lastname: Bastani
keywords: Internet; attitudes; health knowledge; machine learning; personal narratives; practice; social media; vaccination