Electronic Cigarette Users' Perspective on the COVID-19 Pandemic: Observational Study Using Twitter Data

Social media crisis communication and public engagement during COVID-19 analyzing public health and news media organizations' tweeting strategies

This study investigates early COVID-19 communication strategies and content of four public health and four news media organizations across Australia, China, the UK, and the US on X (formerly Twitter) and their public engagement. 15,711 COVID-19-related tweets from the selected accounts posted from January 1 to May 19, 2020, were collected using a web crawler. Public engagement was measured through replies, retweets, and likes. The tweets were grouped into 37 clusters using unsupervised learning and analyzed thematically based on the top 30 tweets per cluster. Descriptive statistics quantified the tweets and their engagement, and a chi-square test compared differences between the two organization types across topics. Six topics were identified: "policies, methods, and action", "case updates", "opinions and responses", "medical research and treatment information", "impacts and consequences", and "health instructions and suggestions", with five communication phases: inception, awareness, panic, spreading, and cohabitation. Analysis revealed that more hashtags and longer texts were associated with lower engagement, except for tweets on "medical research and treatment information" and "health instructions and suggestions". Our study indicated that fewer hashtags and concise language might improve public engagement, while detailed content with more hashtags was effective for specific health instructions. Overall, tweets about treatment progress and health guidance received the most engagement.

General practitioners' wellbeing during the COVID-19 pandemic: Novel methods with social media data

BACKGROUND

It is difficult to engage busy healthcare professionals in research. Yet during the COVID-19 pandemic, gaining their perspectives has never been more important.

OBJECTIVE

To explore social media data for insights into the wellbeing of UK General Practitioners (GPs) during the Covid-19 pandemic.

METHODS

We used a combination of search approaches to identify 381 practising UK NHS GPs on Twitter. Using a two stage social media analysis, we firstly searched for key themes from 91,034 retrieved tweets (before and during the pandemic). Following this we used qualitative content analysis to provide in-depth insights from 7145 tweets related to wellbeing.

RESULTS

Social media proved a useful tool to identify a cohort of UK GPs; following their tweets longitudinally to explore key themes and trends in issues related to GP wellbeing during the pandemic. These predominately related to support, resources and public perceptions and fluctuations were identified at key timepoints during the pandemic, all achieved without burdening busy GPs.

CONCLUSION

Social media data can be searched to identify a cohort of GPs to explore their wellbeing and changes over time.

Social Network Ties and Responses to COVID-19 Among E-Cigarette Users

Social networks can enhance behavioral changes or entrench existing patterns of behavior. We aimed to identify how network ties to other e-cigarette users shaped responses to the pandemic and e-cigarette considerations. A national U.S. survey of 562 e-cigarette users was conducted during April 2020. Participants self-reported network ties to other e-cigarette users and pandemic outcomes: receiving expressions of concern about vaping, risk for a bad COVID outcome, changes in e-cigarette risk perceptions, and considerations of quitting. Each additional e-cigarette user tie was associated with a 0.014 unit increase in expressions of concern (p < 0.001), a 0.034 unit increase in perceived risk of a bad outcome (p < 0.05), and 3.9% higher odds of quit considerations (OR = 1.039; p < 0.01). Family ties to e-cigarette users were particularly important. Additional e-cigarette users within a network shaped risk perceptions in response to COVID-19. Network ties to other e-cigarette users have implications for cessation or reduction of e-cigarette use.

Unmasking the Twitter Discourses on Masks During the COVID-19 Pandemic: User Cluster-Based BERT Topic Modeling Approach

BACKGROUND

The COVID-19 pandemic has spotlighted the politicization of public health issues. A public health monitoring tool must be equipped to reveal a public health measure's political context and guide better interventions. In its current form, infoveillance tends to neglect identity and interest-based users, hence being limited in exposing how public health discourse varies by different political groups. Adopting an algorithmic tool to classify users and their short social media texts might remedy that limitation.

OBJECTIVE

We aimed to implement a new computational framework to investigate discourses and temporal changes in topics unique to different user clusters. The framework was developed to contextualize how web-based public health discourse varies by identity and interest-based user clusters. We used masks and mask wearing during the early stage of the COVID-19 pandemic in the English-speaking world as a case study to illustrate the application of the framework.

METHODS

We first clustered Twitter users based on their identities and interests as expressed through Twitter bio pages. Exploratory text network analysis reveals salient political, social, and professional identities of various user clusters. It then uses BERT Topic modeling to identify topics by the user clusters. It reveals how web-based discourse has shifted over time and varied by 4 user clusters: conservative, progressive, general public, and public health professionals.

RESULTS

This study demonstrated the importance of a priori user classification and longitudinal topical trends in understanding the political context of web-based public health discourse. The framework reveals that the political groups and the general public focused on the science of mask wearing and the partisan politics of mask policies. A populist discourse that pits citizens against elites and institutions was identified in some tweets. Politicians (such as Donald Trump) and geopolitical tensions with China were found to drive the discourse. It also shows limited participation of public health professionals compared with other users.

CONCLUSIONS

We conclude by discussing the importance of a priori user classification in analyzing web-based discourse and illustrating the fit of BERT Topic modeling in identifying contextualized topics in short social media texts.

Discussions and Misinformation About Electronic Nicotine Delivery Systems and COVID-19: Qualitative Analysis of Twitter Content

Background

Misinformation and conspiracy theories related to COVID-19 and electronic nicotine delivery systems (ENDS) are increasing. Some of this may stem from early reports suggesting a lower risk of severe COVID-19 in nicotine users. Additionally, a common conspiracy is that the e-cigarette or vaping product use–associated lung injury (EVALI) outbreak of 2019 was actually an early presentation of COVID-19. This may have important public health ramifications for both COVID-19 control and ENDS use.

Objective

Twitter is an ideal tool for analyzing real-time public discussions related to both ENDS and COVID-19. This study seeks to collect and classify Twitter messages (“tweets”) related to ENDS and COVID-19 to inform public health messaging.

Methods

Approximately 2.1 million tweets matching ENDS-related keywords were collected from March 1, 2020, through June 30, 2020, and were then filtered for COVID-19–related keywords, resulting in 67,321 original tweets. A 5% (n=3366) subsample was obtained for human coding using a systematically developed codebook. Tweets were coded for relevance to the topic and four overarching categories.

Results

A total of 1930 (57.3%) tweets were coded as relevant to the research topic. Half (n=1008, 52.2%) of these discussed a perceived association between ENDS use and COVID-19 susceptibility or severity, with 42.4% (n=818) suggesting that ENDS use is associated with worse COVID-19 symptoms. One-quarter (n=479, 24.8%) of tweets discussed the perceived similarity/dissimilarity of COVID-19 and EVALI, and 13.8% (n=266) discussed ENDS use behavior. Misinformation and conspiracy theories were present throughout all coding categories.

Conclusions

Discussions about ENDS use and COVID-19 on Twitter frequently highlight concerns about the susceptibility and severity of COVID-19 for ENDS users; however, many contain misinformation and conspiracy theories. Public health messaging should capitalize on these concerns and amplify accurate Twitter messaging.

The COVID-19 Pandemic and Mental Health Concerns on Twitter in the United States

Background

During the COVID-19 pandemic, mental health concerns (such as fear and loneliness) have been actively discussed on social media. We aim to examine mental health discussions on Twitter during the COVID-19 pandemic in the US and infer the demographic composition of Twitter users who had mental health concerns.

Methods

COVID-19-related tweets from March 5th, 2020, to January 31st, 2021, were collected through Twitter streaming API using keywords (i.e., "corona," "covid19," and "covid"). By further filtering using keywords (i.e., "depress," "failure," and "hopeless"), we extracted mental health-related tweets from the US. Topic modeling using the Latent Dirichlet Allocation model was conducted to monitor users' discussions surrounding mental health concerns. Deep learning algorithms were performed to infer the demographic composition of Twitter users who had mental health concerns during the pandemic.

Results

We observed a positive correlation between mental health concerns on Twitter and the COVID-19 pandemic in the US. Topic modeling showed that "stay-at-home," "death poll," and "politics and policy" were the most popular topics in COVID-19 mental health tweets. Among Twitter users who had mental health concerns during the pandemic, Males, White, and 30-49 age group people were more likely to express mental health concerns. In addition, Twitter users from the east and west coast had more mental health concerns.

Conclusions

The COVID-19 pandemic has a significant impact on mental health concerns on Twitter in the US. Certain groups of people (such as Males and White) were more likely to have mental health concerns during the COVID-19 pandemic.

Perceptions of Oral Nicotine Pouches on Reddit: Observational Study (Preprint)

Background

Oral nicotine pouches are a new form of tobacco-free nicotine products launched in recent years with a variety of flavors.

Objective

This study aims to examine the public perceptions and discussions of oral nicotine pouches on Reddit, a popular social media platform for sharing user experiences.

Methods

Between February 15, 2019, and February 12, 2021, a total of 2410 Reddit posts related to oral nicotine pouches were obtained over a 2-year period. After the removal of unrelated or commercial posts, 653 Reddit posts related to oral nicotine pouches remained. Topics and sentiments related to oral nicotine pouches on Reddit were hand coded.

Results

The number of Reddit posts related to oral nicotine pouches increased during the study period. Content analysis showed that the most popular topic was “sharing product information and user experience” (366/653, 56%), in which sharing oral nicotine pouch products and user experiences were dominant. The next popular topic was “asking product-related questions” (product properties and product recommendations; 115/653, 17.6%), followed by “quitting nicotine products” such as vaping or smoking through use of oral nicotine pouches or quitting the oral nicotine pouches themselves (83/653, 12.7%) and “discussing oral nicotine pouch–related health” symptoms or concerns related to oral nicotine pouches (74/653, 11.3%). The least popular topic was “legality and permissions” related to oral nicotine pouches (15/653, 2.3%). In addition, a greater number of Reddit posts described positive attitudes compared to negative attitudes toward oral nicotine pouches (354/653, 54.2% vs 101/653, 15.5%; P<.001).

Conclusions

Reddit posts overall had a positive attitude toward oral nicotine pouches and users were actively sharing product and user experiences. Our study provides the first insight on up-to-date oral nicotine pouch discussions on social media.

Use of electronic cigarettes and heated tobacco products during the Covid-19 pandemic

Only a few studies investigated changes in electronic cigarette (e-cigarette) and heated tobacco product (HTP) use during pandemic restrictions. We conducted a web-based cross-sectional study of a representative sample of 6,003 Italian adults during the strictest phase of the Covid-19 lockdown (April–May 2020). Participants were asked to report changes in e-cigarette and HTP use compared to before the pandemic. E-cigarette users increased from 8.1% to 9.1% and HTP users from 4.0% to 4.5%. Among e-cigarette non-users before lockdown, 1.8% started using e-cigarettes during lockdown. New users were more frequently younger (p for trend 0.001), men (odds ratio, OR 1.56; 95% confidence interval, CI: 1.03–2.34), cannabis users (OR 2.35; 95% CI: 1.33–4.13), gamblers (OR 3.34; 95% CI: 2.18–5.11) and individuals with anxiety symptoms (OR 1.58; 95% CI: 1.00–2.52). 1.0% of HTP non-users started using it during lockdown. New users were less frequently current than never cigarette smokers (OR 0.19; 95% CI: 0.06–0.61) and more frequently gamblers (OR 2.23; 95% CI: 1.22–4.07). E-cigarettes and HTPs played little role as smoking cessation tools for hardcore smokers but rather provided opportunities for young never smokers to engage in socially acceptable activities, perhaps reflecting the obstacles they faced in obtaining other addictive substances during confinement.

A high-resolution temporal and geospatial content analysis of Twitter posts related to the COVID-19 pandemic

The COVID-19 pandemic has deeply impacted all aspects of social, professional, and financial life, with concerns and responses being readily published in online social media worldwide. This study employs probabilistic text mining techniques for a large-scale, high-resolution, temporal, and geospatial content analysis of Twitter related discussions. Analysis considered 20,230,833 English language original COVID-19-related tweets with global origin retrieved between January 25, 2020 and April 30, 2020. Fine grain topic analysis identified 91 meaningful topics. Most of the topics showed a temporal evolution with local maxima, underlining the short-lived character of discussions in Twitter. When compared to real-world events, temporal popularity curves showed a good correlation with and quick response to real-world triggers. Geospatial analysis of topics showed that approximately 30% of original English language tweets were contributed by USA-based users, while overall more than 60% of the English language tweets were contributed by users from countries with an official language other than English. High-resolution temporal and geospatial analysis of Twitter content shows potential for political, economic, and social monitoring on a global and national level.

Vaping discussion in the COVID-19 pandemic: An observational study using Twitter data

BACKGROUND

With the spread of COVID-19, significant concerns have been raised about the potential increased risk for electronic cigarette (e-cigarette) users for COVID-19 infection and related syndromes. Social media is an increasingly popular source for health information dissemination and discussion, and can affect health outcomes.

OBJECTIVE

This study aims to identify the topics in the public vaping discussion in COVID-19-related Twitter posts in order to get insight into public vaping-related perceptions, attitudes and concerns, and to discern possible misinformation and misconceptions around vaping in the COVID-19 pandemic.

METHODS

Using the tweets ID database maintained by Georgia State University's Panacea Lab, we downloaded the tweets related to COVID-19 from March 11, 2020, when the World Health Organization declared COVID-19 a pandemic, to February 12, 2021. We used R to analyze the tweets that contained a list of 79 keywords related to vaping. After removing duplicates and tweets created by faked accounts or bots, the final data set consisted of 11,337 unique tweets from 7,710 different users. We performed the latent Dirichlet allocation (LDA) algorithm for topic modeling and carried out a sentiment analysis.

RESULTS

Despite fluctuations, the number of daily tweets was relatively stable (average number of daily tweets = 33.4) with a sole conspicuous spike happening on a few days after August 11, 2020 when a research team published findings that teenagers and young adults who vape face a much higher risk of COVID-19 infection than their peers who do not vape. Topic modeling generated 8 topics: linkage between vaping and risk of COVID-19 infection, vaping pneumonia and the origin of COVID-19, vaping and spread of COVID-19, vaping regulation, calling for quitting vaping, protecting youth, similarity between e-cigarette or vaping-associated lung injury (EVALI) and COVID-19, and sales information. Daily sentiment scores showed that the public sentiment was predominantly negative, but became slightly more positive over the course of the study time period.

CONCLUSIONS

While some content in the public discourse on vaping before the COVID-19 pandemic continued in Twitter posts during the COVID-19 time period, new topics emerged. We found a substantial amount of anti-vaping discussion and dominantly negative sentiment around vaping during COVID-19, a sharp contrast to the predominantly pro-vaping voice on social media in the pre-COVID-19 period. Continued monitoring of social media conversations around vaping is needed, and the public health community may consider using social media platforms to actively convey scientific information around vaping and vaping cessation.

Vaping and COVID-19 Risk: Perceived link and its correlates among at-risk adolescents

Research shows that a significant number of adolescents and young adults quit vaping or reduced the amount of nicotine consumed since the beginning of the COVID-19 pandemic. However, there is a lack of evidence on adolescent risk perceptions regarding the link between vaping and susceptibility to contracting COVID-19. This study examined the level of perceived COVID-19 risk due to vaping among at-risk adolescents. A sample (N = 1,251) of adolescents aged 13 to 17 and susceptible to future vaping were recruited through Qualtrics to participate in an online survey. More than two thirds of the sample (68.34%) reported that vaping would increase one's risk of contracting COVID-19. Ordinal logistic regression showed that this risk perception was positively associated with perceived prevalence of vaping among peers (AOR = 1.186, 95%CI = 1.019-1.382) and prior exposure to vaping product advertising (AOR = 1.371, 95%CI = 1.221-1.539), and negatively associated with past 30-day vaping (AOR = 0.579, 95%CI = 0.406-0.825) and number of closest friends who vaped (AOR = 0.873, 95%CI = 0.779-0.978). Further analysis stratified by past 30-day vaping showed that, among those who vaped in the past 30 days, vaping-related covid risk perception was positively associated with susceptibility to future vaping (AOR = 1.562, 95%CI = 1.161-2.101) and sensation-seeking (AOR = 1.212, 95%CI = 1.003-1.463). These results are open to different interpretations because of the cross-sectional nature of the data. Additional research is needed to better understand the observed relationships and their implications for vaping prevention during the pandemic.

Vaping and COVID-19: Insights for Public Health and Clinical Care from Twitter

This study describes key topics of discussions on Twitter at the intersection of vaping and COVID-19 and documents public reactions to announcements from authoritative health agencies. Twitter posts containing vaping and COVID-19-related terms were collected from 1 December 2019 to 3 May 2020 (n = 23,103 posts). Text classifiers and unsupervised machine learning were used to identify topics in posts. Predominant topics included COVID-19 Respiratory Health (18.87%), COVID-19 Susceptibility (17.53%), Death (10.07%), Other COVID-19 Health Effects (9.62%), and Severity of COVID-19 (7.72%), among others. Public conversations on topics, such as Severity of COVID-19, Transmission, Susceptibility, Health Effects, Death, and Smoking cessation, were shaped by announcements from U.S. and international health agencies. Armed with the insights from this study, medical providers should be prepared to discuss vaping-related health risks with their patients in the era of COVID-19. Misconceptions around vaping as a protective behavior from, and an effective treatment against, COVID-19 should also be corrected.

Public Perception of COVID-19 Vaccines on Twitter in the United States

Background

COVID-19 vaccines play a vital role in combating the COVID-19 pandemic. Social media provides a rich data source to study public perception of COVID-19 vaccines.

Objective

In this study, we aimed to examine public perception and discussion of COVID-19 vaccines on Twitter in the US, as well as geographic and demographic characteristics of Twitter users who discussed about COVID-19 vaccines.

Methods

Through Twitter streaming Application Programming Interface (API), COVID-19-related tweets were collected from March 5 th , 2020 to January 25 th , 2021 using relevant keywords (such as "corona", "covid19", and "covid"). Based on geolocation information provided in tweets and vaccine-related keywords (such as "vaccine" and "vaccination"), we identified COVID-19 vaccine-related tweets from the US. Topic modeling and sentiment analysis were performed to examine public perception and discussion of COVID-19 vaccines. Demographic inference using computer vision algorithm (DeepFace) was performed to infer the demographic characteristics (age, gender and race/ethnicity) of Twitter users who tweeted about COVID-19 vaccines.

Results

Our longitudinal analysis showed that the discussion of COVID-19 vaccines on Twitter in the US reached a peak at the end of 2020. Average sentiment score for COVID-19 vaccine-related tweets remained relatively stable during our study period except for two big peaks, the positive peak corresponds to the optimism about the development of COVID-19 vaccines and the negative peak corresponds to worrying about the availability of COVID-19 vaccines. COVID-19 vaccine-related tweets from east coast states showed relatively high sentiment score. Twitter users from east, west and southern states of the US, as well as male users and users in age group 30-49 years, were more likely to discuss about COVID-19 vaccines on Twitter.

Conclusions

Public discussion and perception of COVID-19 vaccines on Twitter were influenced by the vaccine development and the pandemic, which varied depending on the geographics and demographics of Twitter users.

Investigating the Impact of New York State Flavor Ban on E-cigarettes Discussion on Twitter: Observational Study (Preprint)

Background

On May 18, 2020, the New York State Department of Health implemented a statewide flavor ban to prohibit the sales of all flavored vapor products, except for tobacco or any other authorized flavor.

Objective

This study aims to investigate the discussion changes in e-cigarette–related tweets over time with the implementation of the New York State flavor ban.

Methods

Through the Twitter streaming application programming interface, 59,883 e-cigarette–related tweets were collected within the New York State from February 6, 2020, to May 17, 2020 (period 1, before the implementation of the flavor ban), May 18, 2020-June 30, 2020 (period 2, between the implementation of the flavor ban and the online sales ban), July 1, 2020-September 15, 2020 (period 3, the short term after the online sales ban), and September 16, 2020-November 30, 2020 (period 4, the long term after the online sales ban). Sentiment analysis and topic modeling were conducted to investigate the changes in public attitudes and discussions in e-cigarette–related tweets. The popularity of different e-cigarette flavor categories was compared before and after the implementation of the New York State flavor ban.

Results

Our results showed that the proportion of e-cigarette–related tweets with negative sentiment significantly decreased (4305/13,246, 32.5% vs 3855/14,455, 26.67%, P<.001), and tweets with positive sentiment significantly increased (5246/13,246, 39.6% vs 7038/14,455, 48.69%, P<.001) in period 4 compared to period 3. “Teens and nicotine products” was the most frequently discussed e-cigarette–related topic in the negative tweets. In contrast, “nicotine products and quitting” was more prevalent in positive tweets. The proportion of tweets mentioning mint and menthol flavors significantly increased right after the flavor ban and decreased to lower levels over time. The proportions of fruit and sweet flavors were most frequently mentioned in period 1, decreased in period 2, and dominated again in period 4.

Conclusions

The proportion of e-cigarette–related tweets with different attitudes and frequently discussed flavor categories changed over time after the implementation of the New York State ban of flavored vaping products. This change indicated a potential impact of the flavor ban on public discussions of flavored e-cigarettes.