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Exposure to lead has long been a community health concern in St. Louis, Missouri. The objective of this study was to examine public response to reports of elevated lead levels in school drinking water in St. Louis, Missouri via Twitter, a microblogging platform with over 320 million active users. We used a mixed-methods design to examine Twitter user status updates, known as "tweets," from 18 August to 31 December 2016. The number of tweets each day was recorded, and Twitter users were classified into five user types (General Public, Journalist/News, Health Professional/Academic, Politician/Government Official, and Non-Governmental Organization). A total of 492 tweets were identified during the study period. The majority of discourse on Twitter occurred during the two-week period after initial media reports and was driven by members of the General Public. Thematic analysis of tweets revealed four themes: Information Sharing, Health Concerns, Sociodemographic Disparities, and Outrage. Twitter users characterized lead in school drinking water as an issue of environmental inequity. The findings of this study provide evidence that social media platforms can be utilized as valuable tools for public health researchers and practitioners to gauge public sentiment about environmental health issues, identify emerging community concerns, and inform future communication and research strategies regarding environmental health hazards.

Examining Public Perceptions about Lead in School Drinking Water: A Mixed-Methods Analysis of Twitter Response to an Environmental Health Hazard