Examining the Peer-Reviewed Literature on Tobacco-Related Social Media Data: Scoping Review

INTRODUCTION

Tobacco researchers have used social media data to examine tobacco industry marketing practices (eg, influencers), and to document user experience with tobacco products. This study summarized the literature that analyzed tobacco-related social media data, including domain, social media platform, tobacco product type, and themes of findings, among other variables.

AIMS AND METHODS

PubMed, PsycINFO, Web of Science, and Communication Source were searched between 2004 and 2022. Peer-reviewed articles were included if they were written in English, included at least one tobacco-related term, and one social media-related term, and analyzed a social media post. Two coders screened all-titles and abstracts. The final sample consisted of (n = 255) articles. Studies were coded for domain, social media platform, tobacco product type, data source, type of data, coding and analytic method, and presence of validation procedure, among other variables.

RESULTS

A total of 10 504 820 581 tobacco-related social media posts were assessed across 255 studies. User experience (54.1%) and promotion (23.1%) were the most researched domains. Researchers used data from Twitter the most (42.7%). Text (43.1%) was the most common type of data analyzed. Thematic analysis (80.8%) was the most common analytic technique. Themes of findings from content analyses often pertained to the health effects of tobacco use (61.0%) and promotion (44.2%).

CONCLUSIONS

Researchers have analyzed billions of tobacco-related social media posts to describe user experience with, and promotions related to, tobacco products like e-cigarettes on platforms like Twitter. Future research may examine tobacco-related social media data from newer platforms like TikTok.

IMPLICATIONS

Real-time surveillance of tobacco-related content on social media can keep the tobacco control community abreast of tobacco industry promotional strategies, user experience with tobacco products, and perceived health effects of tobacco use. A framework may be developed to establish best-practices for social media data collection and analysis, including strategies to identify posts from bot accounts and validate methodological approaches used in thematic analysis.

Examining Tobacco-Related Social Media Research in Government Policy Documents: Systematic Review

BACKGROUND

Social media data have been used to describe tobacco industry marketing practices, user experiences with tobacco, and youth-oriented protobacco content.

OBJECTIVE

Examine the extent to which tobacco-related social media research is cited in government policy documents.

SEARCH METHODS

Peer-reviewed tobacco-related social media studies were searched for on Web of Science, PubMed, and other databases from 2004 to 2022. The DOI number for each identified article was then used to search the Overton database to find policy documents citing such research. A secondary, manual search of national and international governmental agency websites was also conducted.

SELECTION CRITERIA

Documents were included in this study if they were tobacco-related, written in English, cited social media research in the document text and reference section, and were published by a governmental office or agency.

DATA COLLECTION AND ANALYSIS

The analytic sample consisted of (n = 38) government policy documents, and were coded for content themes, agency type, document type, and subsequent citations.

MAIN RESULTS

When this research was utilized, it was often in the context of highlighting tobacco industry marketing practices, bringing attention to an issue (eg, youth e-cigarette use), and/or describing how social media platforms can be used as a data source to understand tobacco-related attitudes and behaviors. Agencies that often cited this research were the WHO, FDA, and CDC. The document types included research reports, policy recommendations, industry guidance, legal complaints, and practice-based recommendations.

CONCLUSIONS

Tobacco-related social media research has been utilized by government agencies in the last decade to guide the policy process.

IMPLICATIONS

Tobacco-related social media research has been used in government policy documents to detail tobacco industry marketing and bring attention to youth exposure to protobacco content online. Continued surveillance of social media may be necessary to track the changing tobacco landscape.

Oral Nicotine Gum Discussions on Twitter: Content Analysis

BACKGROUND

Oral nicotine gum such as LUCY, which comes in colorful packaging, mimicking traditional chewing gum, is becoming popular. Many brands of gum have not been approved by the FDA for smoking cessation. This study examined public discourse about, including sentiment toward, oral nicotine gum on Twitter.

METHODS

We used Twitter's Streaming Application Programming Interface to collect data from January 1, 2021, to December 21, 2021, using "nicotine gum" and/or "#nicotinegum" search terms (N = 19 171 unique tweets were collected). We used an inductive approach to become familiar with the data, generated a codebook, and conducted a content analysis on (n = 2152) tweets.

RESULTS

Cessation (n = 716, 33.3%), personal experience (n = 370, 17.2%), and addiction to gum (n = 135, 6.3%) were the most prevalent themes. Cessation tweets primarily discussed cigarette smoking cessation (n = 418, 58.4% of cessation tweets) and successful cessation experiences (n = 155, 21.6%). Other identified themes pertained to using nicotine gum for cognitive enhancement or catching a "buzz" (n = 102, 4.7%), marketing (n = 98, 4.6%), using nicotine gum with other substances (n = 90, 4.2%), and adverse effects (n = 63, 2.9%). Sentiment analysis results revealed that 675 (44.2%) tweets were categorized as neutral, 605 (39.6%) tweets were classified as positive, and 248 tweets (16.2%) were negative.

CONCLUSIONS

About one-third of tweets in our corpus mentioned nicotine gum in the context of smoking cessation. Most nicotine gum-related posts conveyed positive and neutral sentiments. Future studies should consider adding novel nicotine gum-specific search terms as well as exploring other social media platforms to gain more insights about these products.

IMPLICATIONS

Our findings suggest that Twitter has the potential to track and facilitate conversations between those seeking cigarette cessation advice and those who have successfully quit tobacco by using nicotine gum. Monitoring of promotional content from nicotine gum companies is needed to ensure these products are not appealing to youth and nonusers of tobacco.

Content analysis of email marketing communications among online e-cigarette retailers

INTRODUCTION

Online e-cigarette retailers use email communications to promote products directly to consumers, which may facilitate e-cigarette use. Little is known about the content of these emails. As such, this study collected emails from online e-cigarette retailers in California to conduct a content analysis.

METHODS

This study included 13 online e-cigarette retailers in California using Yelp. To be included in the study, e-cigarette retailers needed a live website, physical retail location (i.e., vape shop), and e-cigarettes available for purchase online. The research team entered each website and signed up (if possible) for an email newsletter. Data were collected from the Gmail Application Programming Interface over a 1-year study period (11/01/21-11/01/22). Members of the research team coded emails for the presence of e-cigarettes, other products, flavors, marketing categories, and promotional activities, among other variables.

RESULTS

749 promotional emails (2.1 avg/per day) were received over the 1-year study period. Second-generation e-cigarettes (n=581, 77.6%) were the most observed product in emails followed by disposable e-cigarettes (n=391, 52.2%). The most common flavor profile was fruit/sweet/liquor (n=424, 56.6%). Emails included links to social media pages (n=366, 48.9%). Online coupons were found in 53.1% (n=398) of the emails. Age warnings were displayed in 8.0% (n=60) of the emails.

CONCLUSIONS

E-cigarette retailers' emails promoted new products, flavors, and contained promotional discounts. Future research should examine the impact of exposure to such emails on e-cigarette-related attitudes and behaviors.

IMPLICATIONS

Findings from this study may help inform prevention programs and interventions focused on increasing tobacco-related digital media literacy (i.e., evaluate tobacco advertising messages on digital media) among gender and ethnic minorities. Future research should examine if exposure to email marketing is causally linked with e-cigarette use among gender and ethnic minorities.

Surveillance of Gun-Related Conversations on Twitter

Gun violence in the USA is a documented public health crisis. Publicly accessible data from Twitter posts can be used to rapidly capture and describe the public's recent conversations about guns. Because these gun-related conversations change rapidly, it is important to provide regularly updated information on them. Twitter posts containing gun-related terms were obtained from January 1, 2022 to June 30, 2022. To understand topics of gun-related tweets (N = 449,492), topic modeling was performed with Top2Vec. Gun ownership control, concern about gun safety and its impact on children and schools, and the Second Amendment were major areas of the gun-related discourse on Twitter. Several identified topics in this study were a consequence of the study period, including "Discourse on Capitol Riots," and "Wartime and Military Use of Guns," with the latter topic containing conversations about the Russia-Ukraine War. Conversations around the influence of the National Rifle Association (NRA) on gun policies and pro-gun ownership perspectives were also part of the public discourse. The intersection between alcohol, substance use, and gun use was infrequently observed. Findings suggest that gun-related conversations in social media such as Twitter can inform public health researchers.

Online Purchase Attempts of Flavored E-Cigarettes to Minors in California Before and After Senate Bill 793

This survey study assesses whether the online purchase attempt completion rate of e-cigarettes changed after passage of California Senate Bill 793.

Cartoon marketing exposure decreases perceived risks of e-cigarette use in adolescents

e-Cigarette companies use cartoon images to market their products, and exposure to this marketing strategy may lead to increased risk for adolescent e-cigarette use. This study examined the effects of cartoon marketing image exposure on perceived expectations of benefits and risks of e-cigarette use, and willingness to buy e-cigarette-related products in the future, among adolescents with and without a history of e-cigarette use. To accomplish this, participants completed an online survey experiment, during which they were randomly assigned to view pictures of e-cigarette products with cartoon or noncartoon packaging, followed by questionnaires about wanting to buy e-cigarettes, and perceived benefits and risks of e-cigarette use. Participants, a sample of Southern California high school students (ninth to 11th grade; N = 1,376), completed the study from September 2021 to November 2021. Overall, 27% of participants had used an e-cigarette or other tobacco product at least once in their lifetime (ever user). Thirty-six percent of participants never used e-cigarettes or other tobacco products but were considered to be susceptible to using e-cigarettes in the future (susceptible-never user). Thirty-seven percent of participants never used e-cigarettes or other tobacco products and were considered insusceptible to using e-cigarettes in the future (insusceptible-never user). There were no significant differences between image exposure groups (cartoon, no cartoon) on demographic variables (age, gender, race/ethnicity), lifetime e-cigarette use, or susceptibility to use in the future. Exposure to e-cigarette-related cartoon-based marketing produced lower perceived e-cigarette-related risks in insusceptible-never users. Exposure to e-cigarette marketing with cartoon images decreases the perceived harmfulness of e-cigarettes, which can increase adolescents' intentions to try e-cigarettes. Curbing adolescent e-cigarette use is a national public health priority. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Spanish-language tobacco-related posts on Twitter: content analysis

INTRODUCTION

Twitter data has been used to surveil public sentiment about tobacco products, however, most tobacco-related Twitter research has been conducted with English-language posts. There is a gap in the literature on tobacco-related discussions on Twitter in languages other than English. This study summarized tobacco-related discussions in Spanish on Twitter.

METHODS

A set of Spanish terms reflecting electronic cigarettes (e.g., cigarillos electrónicos), cigarettes (e.g., "pitillo"), and cigars (e.g., "cigaro") were identified. A content analysis of tweets (n=1,352) drawn from 2021 was performed to examine themes and sentiment. An initial codebook was developed in English then translated to Spanish and then translated back to English by a bilingual (Spanish and English) member of the research team. Two bilingual members of the research team coded the tweets into themes and sentiment.

RESULTS

Themes in the tweets included 1) product promotion (n=168, 12.4%), 2) health warnings (n=161, 11.9%), 3) tobacco use (n=136, 10.1%), 4) health benefits of vaping (n=58, 4.3%), 5) cannabis use (n=50, 3.7%), 6) cessation (n=47, 3.5%), 7) addiction (n=33, 2.4%), 8) policy (n=27, 2.0%), and 9) polysubstance use (n=12, 0.9%). Neutral (n=955, 70.6%) was the most common category of sentiment observed in the data.

CONCLUSIONS

Tobacco products are discussed in multiple languages on Twitter and can be summarized by bilingual research teams. Future research should determine if Spanish-speaking individuals are frequently exposed to pro-tobacco content on social media and if such exposure increases susceptibility to use tobacco among never users or sustained use among current users.

IMPLICATIONS

Spanish-language pro-tobacco content exists on Twitter, which has implications for Spanish-speaking individuals who may be exposed to this content. Spanish-language pro-tobacco-related posts may help normalize tobacco use among Spanish-speaking populations. As a result, anti-tobacco tweets in Spanish may be necessary to counter areas of the online environment that can be considered pro-tobacco.

Monitoring the Official YouTube Channels of E-Cigarette Companies: A Thematic Analysis

BACKGROUND

E-cigarette companies use YouTube to foster brand awareness, market their products, and interact with current and future tobacco users. However, research on the official YouTube channels of e-cigarette companies is limited. This study determined the themes of, and degree of user engagement with, videos posted to the official channels of e-cigarette companies on YouTube.

METHODS

Data were collected from the official YouTube channels of seven e-cigarette companies by scraping (i.e., electronically copying) the videos. The earliest video was posted on October 10, 2013, and the most recent video was posted on April 22, 2021 (n = 260). An inductive approach was used to identify themes in the data. User engagement with posts including number of likes, dislikes, and comments were also collected.

RESULTS

Prevalent themes included branding (n = 250 of 260 videos, 96%), youth use (n = 222, 85%), and tobacco use (n = 210, 81%), while less common themes included misleading health statements (n = 4, 2%), personal choice (n = 4, 2%), and antitobacco (n = 2, 1%). Videos that contained the themes testimonial, product design features, and instructional received the highest mean number of likes. Videos that contained the themes antitobacco, cessation, and testimonial received the highest mean number of dislikes. The 260 videos in this study were collectively viewed 6,619,700 times as of May 5, 2021.

CONCLUSIONS

Videos from the official YouTube channels of seven e-cigarette companies often focused on branding and user experience but rarely mentioned cessation. While videos about cessation were rare, they received the second highest mean number of dislikes. Future research should assess the impact of exposure to e-cigarette-related content on YouTube and e-cigarette-related attitudes and behaviors.

Monitoring website marketing among leading e-cigarette brands and vendors in California: content analysis

BACKGROUND

Electronic cigarette (e-cigarette) brands and vendors use websites to promote pro-tobacco messages that may increase susceptibility to use e-cigarettes among never users or help sustain continued e-cigarette use among current users. E-cigarette website marketing is lightly regulated, and little is known about promotional strategies used on e-cigarette companies' websites. This study conducted a content analysis of website marketing from leading e-cigarette companies selling products in California.

METHODS

This study identified 20 e-cigarette vendors and 6 e-cigarette brands that had products available for purchase online in California. Two coders visited 26 websites between 06 February 2022 and 17 April 2022. Websites were coded for marketing themes, promotional and interactive content, availability of flavoured e-cigarette products, presence of health warnings, and reference to tobacco control policies.

RESULTS

Marketing themes related to physical health benefits of e-cigarette use were found on 50.0% of the websites. 57.7% of the websites had sales/discounts/coupons. 65.4% of the websites had fruit-flavoured disposable e-cigarettes, while 73.1% of the websites had fruit-flavoured e-liquids available for purchase. 69.2% of the websites allowed users to sign up for email newsletters, and 88.9% of such websites did not require users to create an age-verified account to receive email newsletters.

CONCLUSIONS

Findings from this study can be used to inform statewide regulations of promotional communications found on e-cigarette companies' websites and encourage enforcement of age-verification procedures. This may help reduce susceptibility to use, or continued use of, e-cigarette products among price-sensitive populations, such as adolescents and young adults.

A thematic analysis of Puff Bar-related content on TikTok

Background: Puff Bar has rapidly captured a large proportion of the disposable e-cigarette market. To stay abreast of the rapidly changing e-cigarette-product landscape, researchers have turned to social media platforms to monitor e-cigarette-related discussions and marketing trends. TikTok is the latest social media platform to capture the attention of adolescents and young adults; however, e-cigarette-related research using TikTok is limited. Objectives: This study examined Puff Bar-related posts on TikTok to identify themes and user engagement. Methods: Data were collected by scraping publicly available TikTok posts that contained the hashtag #puffplus, between January 31, 2020 and May 4, 2021 (n = 581). The research team used an inductive approach to identify 19 themes from the data. User engagement with posts including the number of likes, shares, plays, and comments was also collected. Results: The most prevalent themes included Music at 75.39% (438/581), followed by Flavors at 51.64% (300/581), Youth/Young Adults at 42.86% (249/581), Tobacco Use at 41.14% (239/581), Nicotine Concentration at 35.11% (204/581), Humor at 19.45% (113/581) and Product Review at 19.1% (111/581). Cessation 1.38% (8/581) and Health Warnings 2.58% (15/581) were two themes rarely observed but commonly engaged with by TikTok users. Conclusions: Health communication strategists should prepare to address TikTok's popularity to combat its contribution to the online e-cigarette environment. Future research should determine the impact of exposure to Puff Bar-related content on TikTok on adolescents' and young adults' attitudes and behaviors.

An Analysis of Twitter Posts About the U.S. Food and Drug Administration's Menthol Ban

INTRODUCTION

Although the U.S. Food and Drug Administration (FDA) banned characterizing flavors in cigarettes in 2009, this initial ban exempted menthol. After examining numerous reports on the adverse health effects of menthol cigarettes, the FDA proposed a menthol ban in April 2022. This study analyzed Twitter data to describe public reaction to this announcement.

AIMS AND METHODS

Posts containing the word "menthol" and/or "#menthol" were collected from April 21, 2022 to May 5, 2022 from Twitter's Streaming Application Programming Interface (API). A random sampling procedure supplied 1041 tweets for analysis. Following an inductive approach to content analysis, posts were classified into one or more of 11 themes.

RESULTS

Posts discussed the FDA announcement (n = 153, 14.7%), racial discrimination (n = 101, 9.7%), distrust in government (n = 67, 6.4%), inconsistencies between policies (n = 52, 5.0%), public health benefits (n = 42, 4%), freedom of choice (n = 22, 2.1%), and health equity (n = 21, 2.0%). Posts contained misinformation (n = 20, 1.9%), and discussed the potential for illicit markets (n = 18, 1.7%) and the need for cessation support (n = 4, 0.4%). 541 (52.0%) tweets did not fit into any of the prescribed themes.

CONCLUSIONS

Twitter posts with the word "menthol" commonly discussed distrust in government and mentioned racial discrimination. Findings demonstrated the possibility of near real-time Twitter monitoring of public opinion on a menthol ban. These data may be valuable for designing tobacco control health communication campaigns in the future.

IMPLICATIONS

The U.S. FDA proposed a ban on menthol cigarettes in April 2022. This study's content analyzed Twitter posts over a 2-week period to understand the public's response to the proposed menthol ban. Twitter posts with the word "menthol" often discussed distrust in government and mentioned racial discrimination. Findings demonstrated the possibility of near real-time Twitter monitoring of public opinion of regulatory action. Findings underscore the need to educate the public about the potential health benefits of banning menthol from cigarettes, particularly for populations that experience tobacco-related health disparities.

The Need for Tobacco-Related Interventions to Incorporate Digital Media Literacy

This Viewpoint discusses the need for health promotion programs and interventions to bolster tobacco-related digital media literacy among adolescents, young adults, parents, teachers, and public health organizations.

Describing Memes Referencing Vaping: Thematic Analysis

Background: Memes, images or videos with text overlay that embody a concept or belief about the contemporary society, are endemic to Internet culture, are popular among youth and diffuse rapidly across social media platforms. E-cigarettes and vaping have grown in popularity in the era of Internet culture however there is little research describing the intersection of memes and vaping. This is an important gap in the literature as memes may be part of the broader online e-cigarette information landscape that can normalize vaping among young people. Memes could also point to emerging trends in product preferences. This study content analyzed memes to identify key themes, characters and vape products depicted therein. Methods: Data were drawn from a sub-reddit devoted to vaping-related memes. Memes were electronically copied from the forum to analyze (n = 527). Using an inductive approach, the research team identified 14 themes. Results: In-group communication (n = 202, 38.33%) was the most predominant theme followed by Critique of vaping regulations and public perceptions (n = 76, 14.42%), and Vape device modifications and hacks (n = 62, 11.76%). Memes included Cartoons (n = 124, 23.53%), Celebrities (n = 75, 14.23%), and Fictional characters (n = 53, 10.06%). Memes referenced Tanks or mods (n = 120, 22.77%), Component parts (n = 96, 18.22%) and E-liquids/Nicotine salts (n = 81, 15.37%). Conclusion: Memes referenced in-group communication and cartoons among other youth friendly images, raising concern about the potential to normalize vaping-related behaviors. Future research should monitor emerging vape devices and determine the impact of memes on attitudes and behaviors among adolescents and young adults. Implications: Given the popularity and reach of memes among youth, continuous monitoring of vaping-related memes may reveal aspects that may be addressed in vaping prevention campaigns.

E-cigarette imagery in Netflix scripted television and movies popular among young adults: A content analysis

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The MSA does not restrict e-cigarette product placement in television and film.

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This study analyzed Netflix original TV and films for e-cigarette-related content.

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Out of 125 titles, 16 (13%) had e-cigarette-related content.

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The total time of e-cigarettes onscreen amounted to 399 s.

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Findings contradict Netflix’s no-e-cigarette pledge for PG-13 content.

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Further outside-party monitoring of e-cigarettes in Netflix programming is needed.

Introduction

Research is needed to understand the frequency of e-cigarette impressions in scripted television and movies, especially in scripted content with characters and storylines that may appeal to young adults. This study aimed to determine the extent of e-cigarette-related imagery and dialogue in Netflix content popular with young adults. We also determine the demographics and character qualities of actors shown holding e-cigarettes.

Methods

Nielsen ratings data were used to compile a list of the most popular Netflix original films and TV shows among U.S. viewers 18–24 years old between June 1, 2020, and May 31, 2021. We used a sample of 12 films and 113 TV episodes from 12 series. Three coders were trained to analyze a total of 101 h of content for the presence of e-cigarettes, level of use, type of characters holding e-cigarettes, brand visibility, and the presence of vaping-related dialogue. Twenty percent of all episodes/films were double coded to ensure reliability.

Results

Out of 125 titles, 16 (13%) had e-cigarette-related content. Thirteen titles (10%) showed at least one character holding an e-cigarette, and three others mentioned vaping without showing e-cigarettes. The total time of e-cigarettes onscreen amounted to 399 s and the average screen time for e-cigarettes was 31 s. Ninety-nine percent of the time an e-cigarette appeared on screen it was being held by a character.

Conclusion

This study documented recent e-cigarette imagery found on Netflix and demonstrates the need for health communication campaigns to denormalize e-cigarette use, particularly among susceptible populations, such as young adults.

Association Between Exposure to Tobacco Content on Social Media and Tobacco Use: A Systematic Review and Meta-analysis

Importance

Exposure to tobacco-related content on social media may foster positive attitudes toward tobacco products and brands, and influence the likelihood of initiating or continuing use of tobacco, especially among adolescents and young adults.

Objective

To perform the first systematic review and meta-analysis, to our knowledge, on studies that examined the association between exposure to tobacco content on social media and lifetime tobacco use, past 30-day tobacco use, and susceptibility to use tobacco among never users.

Data Sources

Tobacco, social media, and marketing search terms were entered into online databases, including MEDLINE, ISI Web of Science, Scopus, and PsychINFO. Study characteristics, including research design and methods, sampling strategy, and demographics, were assessed for each study.

Study Selection

Studies reporting odds ratios (ORs) for self-reported exposure to, or experimentally manipulated, tobacco content on social media and lifetime tobacco use, past 30-day tobacco, and susceptibility to use tobacco among never users. The systematic search produced 897 independent articles, of which 29 studies met inclusion criteria.

Data Extraction and Synthesis

A 3-level random-effects meta-analysis was used to estimate ORs, 95% CIs, and heterogeneity (I2) for each tobacco use outcome. Study quality and publication bias were assessed.

Main Outcomes and Measures

Lifetime tobacco use, past 30-day tobacco use, and susceptibility to use tobacco among never users. Tobacco use included e-cigarettes, cigarettes, and other (cigar, hookah, smokeless tobacco).

Results

The total sample size across the 24 included datasets was 139 624, including 100 666 adolescents (72%), 20 710 young adults (15%), and 18 248 adults (13%). Participants who were exposed to tobacco content on social media, compared with those who were not exposed, had greater odds of reporting lifetime tobacco use (OR, 2.18; 95% CI, 1.54-3.08; I2 = 94%), past 30-day tobacco use (OR, 2.19; 95% CI, 1.79-2.67; I2 = 84%), and susceptibility to use tobacco among never users (OR, 2.08; 95% CI, 1.65-2.63; I2 = 73%). Subgroup analyses showed similar associations for tobacco promotions, active engagement, passive engagement, lifetime exposure to tobacco content, exposure to tobacco content on more than 2 platforms, and exposure to tobacco content among adolescents and young adults.

Conclusions and Relevance

Findings suggest that a comprehensive strategy to reduce the amount of tobacco content on social media should be developed by federal regulators. Such actions may have downstream effects on adolescent and young adult exposure to protobacco content, and ultimately tobacco use behaviors.

The impact of e-cigarette product place in music videos on susceptibility to use e-cigarettes among young adults: An experimental investigation

INTRODUCTION

Product placement in music videos is a growing promotional strategy. This study examined the impact of e-cigarette product placement and imagery in music videos on susceptibility to use e-cigarettes among young adults.

METHODS

A non-probability sample of young adults (18 to 24) in Southern California were recruited to participate in an experiment over Zoom. Participants were randomized into a treatment or a control group. The treatment group watched seven music videos with e-cigarette product placement and imagery. The control group watched the same seven music videos with all e-cigarette product placement and imagery digitally removed. Participants completed a questionnaire after watching the music videos. The focus of the analysis was on susceptibility to use e-cigarettes in the future among never users (n = 303).

RESULTS

Participants in the treatment group who had never used e-cigarettes were more likely to report intentions to try e-cigarettes in the future (OR = 1.94, 95% CI [1.08, 3.54], compared to participants in the control group. Participants in the treatment group who had never used e-cigarettes were more likely to report peer influence (OR = 1.97, 95% CI [1.19, 3.32], compared to participants in the control group. While these subitems of susceptibility to use e-cigarettes were statistically significant, the relationship between the treatment group and the composite measure of susceptibility was not.

CONCLUSION

Exposure to e-cigarette product placement in music videos may increase young adults' intentions to try e-cigarettes in the future. Federal, state, and local tobacco control regulatory bodies should consider strategies to reduce e-cigarette product placement in music videos.

Recognition of cartoon-based e-cigarette-related marketing is associated with e-cigarette use among adolescents

INTRODUCTION

Recent research has shown that e-cigarette companies use cartoon-based marketing. Recognition of this cartoon-based marketing has been associated with increased risk for e-cigarette use in young adults, however it is unclear if this generalizes to adolescents. This study examined the associations between recognition of e-liquid packaging with cartoons and e-cigarette use, susceptibility to use, and expectations of benefits and risks of use in adolescents.

METHODS

A cross-sectional sample of adolescents drawn from three Southern California high schools (n = 1,734; 55% female; Mean [SD] age = 15.2[0.9]) completed online surveys assessing e-cigarette use, susceptibility to use, expectations about benefits and risks of use, and tobacco marketing exposure. To assess recognition of cartoon images, participants were presented with 40 images of e-liquid packages (20 with and 20 without cartoons) and asked to endorse whether they recognized the products. The primary predictor was relative cartoon recognition (i.e., percentage of cartoons recognized out of the total images recognized).

RESULTS

Relative recognition of cartoon images was positively associated with e-cigarette use, susceptibility to use, and a perceived social benefit of use.

CONCLUSIONS

Adolescents recognize e-cigarette-related cartoon marketing, and these adolescents are using e-cigarettes. The restriction of cartoon-based marketing of e-cigarettes may affect e-cigarette uptake among adolescents.

Tobacco and cannabis use advertisements targeting adolescents and young adults on Snapchat in 2019

Social media platforms offer opportunities for targeted health communication ads to improve tobacco and cannabis prevention efforts. This study described tobacco and cannabis-related ads targeted towards adolescents and young adults on Snapchat. Data comprised of publicly available tobacco (n = 70) and cannabis-related (n = 64) ads from Snapchat in 2019. Identified themes included: Health consequences (Health effects of tobacco or cannabis use), Financial & legal consequences (Adverse financial or legal implications of substance use), Quitting (Resources for cessation), Industry tactics(Tobacco industry misleads individuals), Policy advocacy (Cannabis law reforms or legalization). Ad performance metrics included average Ad Impressions (number of views per ad) and Ad Spend (cost per ad). Ads were also categorized by Sponsoring Organizations (Government or Advocacy organizations). Health Consequences was the predominant theme followed by Quitting among tobacco-related ads. Government organizations sponsored most tobacco-related ads. Tobacco-related ads targeting adolescents received mean = 4,122,071 impressions and cost mean = $10,385.6 per ad. Tobacco-related ads targeting young adults received mean = 2,151,217 impressions and cost mean = $5,382.1 per ad. Health Consequences was a predominant theme among cannabis-related ads followed by Policy Advocacy. Advocacy organizations sponsored most cannabis-related ads targeting young adults. Cannabis-related ads targeting adolescents received mean = 415,293.8 impressions and cost mean=$793.92 per ad. Cannabis-related ads targeting young adults received mean = 293,267.7 impressions, and cost mean = $740.58. Government and advocacy organization sponsored ads reached millions of adolescents and young adults on Snapchat. Prevention campaigns may consider these number of impressions and cost per ad by theme when designing platform specific ads in the future.

Identifying health-related discussions of cannabis use on Twitter: a content analysis informed by a medical dictionary (Preprint)

Background

The cannabis product and regulatory landscape is changing in the United States. Against the backdrop of these changes, there have been increasing reports on health-related motives for cannabis use and adverse events from its use. The use of social media data in monitoring cannabis-related health conversations may be useful to state- and federal-level regulatory agencies as they grapple with identifying cannabis safety signals in a comprehensive and scalable fashion.

Objective

This study attempted to determine the extent to which a medical dictionary—the Unified Medical Language System Consumer Health Vocabulary—could identify cannabis-related motivations for use and health consequences of cannabis use based on Twitter posts in 2020.

Methods

Twitter posts containing cannabis-related terms were obtained from January 1 to August 31, 2020. Each post from the sample (N=353,353) was classified into at least 1 of 17 a priori categories of common health-related topics by using a rule-based classifier. Each category was defined by the terms in the medical dictionary. A subsample of posts (n=1092) was then manually annotated to help validate the rule-based classifier and determine if each post pertained to health-related motivations for cannabis use, perceived adverse health effects from its use, or neither.

Results

The validation process indicated that the medical dictionary could identify health-related conversations in 31.2% (341/1092) of posts. Specifically, 20.4% (223/1092) of posts were accurately identified as posts related to a health-related motivation for cannabis use, while 10.8% (118/1092) of posts were accurately identified as posts related to a health-related consequence from cannabis use. The health-related conversations about cannabis use included those about issues with the respiratory system, stress to the immune system, and gastrointestinal issues, among others.

Conclusions

The mining of social media data may prove helpful in improving the surveillance of cannabis products and their adverse health effects. However, future research needs to develop and validate a dictionary and codebook that capture cannabis use–specific health conversations on Twitter.

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.

#FlavorsSaveLives: An Analysis of Twitter Posts Opposing Flavored E-cigarette Bans

BACKGROUND

Starting in 2019 policies restricting the availability of flavored e-cigarette products were proposed or implemented in the United States to curb vaping by youth. People took to Twitter to voice their opposition, referencing the phrase "Flavors Save Lives." This study documented the emerging themes pertaining to "Flavors Saves Lives" over a 12-month period.

METHODS

The study period was from May 1, 2019, to May 1, 2020. A stratified sampling procedure supplied 2500 tweets for analysis. Posts were classified by one or more of the following themes: (1) Political Referendum; (2) Institutional Distrust; (3) Individual Rights; (4) Misinformation; (5) THC Vaping is the Real Problem; (6) Smoking Cessation; (7) Adult Use; and (8) Not a Bot. The temporal pattern of tweets over the year was examined.

RESULTS

Political Referendum (76.5%) and Institutional Distrust (31.3%) were the most prominent themes, followed by Not a Bot (11.0%), Individual Rights (10.4%), Adult Use (8.0%), Smoking Cessation (6.6%), Misinformation (5.9%), and THC Vaping is the Real Problem (3.5%). Total tweet frequencies increased in September 2019 and peaked in November 2019 before returning to relatively low numbers. Political Referendum and Institutional Distrust were consistently the most prevalent themes over time.

CONCLUSION

Twitter posts with the phrase "Flavors Save Lives" commonly discussed voting against political incumbents and mentioned distrust of government representatives. Findings demonstrated the possibility of near real-time Twitter monitoring of public opposition to flavor bans. These data may be valuable for designing tobacco control information campaigns in the future.

IMPLICATIONS

(a) Starting in 2019 policies restricting the availability of flavored e-cigarette products were proposed or implemented in the United States to curb vaping by youth. (b) This study content analyzed Twitter posts with the phrase "Flavors Save Lives" from a 12-month period to understand opposition to flavor restrictions. (c) Twitter posts commonly discussed voting against political incumbents and mentioned distrust of government representatives. (d) Findings demonstrated the possibility of near real-time Twitter monitoring of public opposition to flavor bans, and contribute to a more comprehensive assessment of different sub-population's responses to current and proposed tobacco control information policies.

Electronic Cigarette Product Placement and Imagery in Popular Music Videos

INTRODUCTION

Given the increasing use of electronic cigarettes (e-cigarettes) among young adults, it is crucial to identify possible sources of e-cigarette marketing exposure in media popular among young adults. However few studies document e-cigarette product placement (eg, visible logo, branded merchandise or gear such as a branded hat or shirt) in music videos. The objective of this study was to determine the extent of e-cigarette product placement and imagery in popular music videos.

METHODS

Songs on the Billboard Hot 100 list during the weeks of June 16 through September 22, 2018 with official music videos were identified (n = 180) and coded for e-cigarette product placement and imagery (including aerosol clouds), visible brand names, number of views (as of October 25, 2018), music genre, video themes, and combustible tobacco content.

RESULTS

E-cigarette product placement and imagery appeared in 7 (3.8%) music videos which were viewed over a billion times, providing billions of e-cigarette impressions. Among music videos with e-cigarette product placement and imagery, the most prevalent theme was Image/Lifestyle/Sociability (eg, ostentatious lifestyle, partying) and the most prevalent genre was Hip Hop. The e-cigarette companies KandyPens and Mig Vapor were identified.

CONCLUSION

While e-cigarette product placement or imagery appeared in a relatively low number of music videos in this study, these videos received views in the billions. Music videos should be considered when assessing e-cigarette marketing exposure among priority populations. Future research should examine how viewing e-cigarette product placement and imagery in music videos influences susceptibility to use such products among young adults.

IMPLICATIONS

While e-cigarette product placement (eg, scenes with visible branding, a visible logo, branded merchandise or gear such as a branded hat or shirt) or imagery appeared in a relatively low number of popular music videos in this study, these videos received views in the billions on YouTube. KandyPens and Mig Vapor were the companies responsible for the majority of the product placement identified in this study. The predominant music genre of videos featuring any e-cigarette product placement or imagery was Hip Hop, while the predominant theme of videos was Image/Lifestyle/Sociability. Music videos appear to be a potential source of exposure to e-cigarette products. Future research should examine how viewing e-cigarette product placement and imagery in music videos influences susceptibility to use such products among priority populations.

Leading Topics in Twitter Discourse on JUUL and Puff Bar Products: Content Analysis

Background

In response to the recent government restrictions, flavored JUUL products, which are rechargeable closed-system electronic cigarettes (e-cigarettes), are no longer available for sale. However, disposable closed-system products such as the flavored Puff Bar e-cigarette continues to be available. If e-cigarette consumers simply switch between products during the current government restrictions limited to 1 type of product over another, then such restrictions would be less effective. A step forward in this line of research is to understand how the public discusses these products by examining discourse referencing both Puff Bar and JUUL in the same conversation. Twitter data provide ample opportunity to capture such early trends that could be used to help public health researchers stay abreast of the rapidly changing e-cigarette marketplace.

Objective

The goal of this study was to examine public discourse referencing both Puff Bar and JUUL products in the same conversation on Twitter.

Methods

We collected data from Twitter’s streaming application programming interface between July 16, 2019, and August 29, 2020, which included both “Puff Bar” and “JUUL” (n=2632). We then used an inductive approach to become familiar with the data and generate a codebook to identify common themes. Saturation was determined to be reached with 10 themes.

Results

Posts often mentioned flavors, dual use, design features, youth use, health risks, switching 1 product for the other, price, confusion over the differences between products, longevity of the products, and nicotine concentration.

Conclusions

On examining the public’s conversations about Puff Bar and JUUL products on Twitter, having described themes in posts, this study aimed to help the tobacco control community stay informed about 2 popular e-cigarette products with different device features, which can be potentially substituted for one another. Future health communication campaigns may consider targeting the health consequences of using multiple e-cigarette products or dual use to reduce exposure to high levels of nicotine among younger populations.

Topics of Nicotine-Related Discussions on Twitter: Infoveillance Study

BACKGROUND

Cultural trends in the United States, the nicotine consumer marketplace, and tobacco policies are changing.

OBJECTIVE

The goal of this study was to identify and describe nicotine-related topics of conversation authored by the public and social bots on Twitter, including any misinformation or misconceptions that health education campaigns could potentially correct.

METHODS

Twitter posts containing the term "nicotine" were obtained from September 30, 2018 to October 1, 2019. Methods were used to distinguish between posts from social bots and nonbots. Text classifiers were used to identify topics in posts (n=300,360).

RESULTS

Prevalent topics of posts included vaping, smoking, addiction, withdrawal, nicotine health risks, and quit nicotine, with mentions of going "cold turkey" and needing help in quitting. Cessation was a common topic, with mentions of quitting and stopping smoking. Social bots discussed unsubstantiated health claims including how hypnotherapy, acupuncture, magnets worn on the ears, and time spent in the sauna can help in smoking cessation.

CONCLUSIONS

Health education efforts are needed to correct unsubstantiated health claims on Twitter and ultimately direct individuals who want to quit smoking to evidence-based cessation strategies. Future interventions could be designed to follow these topics of discussions on Twitter and engage with members of the public about evidence-based cessation methods in near real time when people are contemplating cessation.

Twitter Surveillance at the Intersection of the Triangulum

INTRODUCTION

A holistic public health surveillance approach can help capture the public's tobacco and marijuana-related attitudes and behaviors. Using publicly available data from Twitter, this is one of the first studies to describe key topics of discussions related to each intersection (e-cigarette, combustible tobacco, and marijuana) of the Triangulum framework.

METHOD

Twitter posts (n=999,447) containing marijuana, e-cigarette and combustible tobacco terms were collected from January 1, 2018, to December 23, 2019. Posts to Twitter with co-occurring mentions of keywords associated with the Triangulum were defined as an intersection (e-cigarettes and combustible tobacco, combustible tobacco and marijuana, e-cigarettes and marijuana, and marijuana, e-cigarettes and combustible tobacco). Text classifiers and unsupervised machine learning was used to identify predominant topics in posts.

RESULTS

Product Features and Cartridges were commonly referenced at the intersection of e-cigarette and marijuana-related conversations. Blunts and Cigars and Drugs and Alcohol were commonly referenced at the intersection of combustible tobacco and marijuana-related discussions. Flavors and Health Risks were discussed at the intersection of e-cigarette and combustible-related conversations, while discussions about Illicit products and Health risks were key topics of discussion when e-cigarettes, combustible tobacco, and marijuana were referenced all together in a single post.

CONCLUSION

By examining intersections of marijuana and tobacco products, this study offers inputs for designing comprehensive FDA regulations including regulating product features associated with appeal, improving enforcement to curb sales of illicit products, and informing the FDA's product review and standards procedures for tobacco products that can be used with marijuana.

IMPLICATIONS

This study is the first to leverage the Triangulum framework and Twitter data to describe key topics of discussions at the intersection of e-cigarette, combustible tobacco, and marijuana. Real-time health communication interventions can identify Twitter users posting in the context of e-cigarettes, combustible tobacco, and marijuana by automated methods and deliver tailored messages. This study also demonstrates the utility of Twitter data for surveillance of complex and evolving health behaviors.

Exposure to E-Cigarette Product Placement in Music Videos Is Associated With Vaping Among Young Adults

BACKGROUND

The prevalence of electronic-cigarette (e-cigarette) product placement in music videos is on the rise and currently unregulated. This promotional activity is concerning given the popularity of music videos among young adults.

AIMS

We examined associations between self-reported levels of exposure to music videos with any e-cigarette product placement or imagery and susceptibility to use e-cigarettes and e-cigarette use.

METHOD

A representative sample of young adults (18-24 years of age), residing in California (n = 1,280), completed online surveys assessing self-reported exposure to music videos with e-cigarette product placement or imagery and susceptibility to use e-cigarettes and e-cigarette use. Adjusted and weighted regression analyses were used for statistical analyses.

RESULTS

Participants exposed to any e-cigarette product placement or imagery in music videos were more likely to report lifetime e-cigarette use (relative risk ratio [RRR]: 2.81) and past 30-day use (RRR: 3.64) compared with participants with no exposure. Additionally, participants with greater levels of exposure were more likely to report lifetime e-cigarette use (RRR: 1.13) and past 30-day use (RRR: 1.20) compared with participants with lower levels of exposure. Among those with any exposure, participants younger than 21 years of age (i.e., under the tobacco purchasing age in the United States) were more likely to report lifetime e-cigarette use (RRR: 4.68) compared with those aged 21 years and older.

DISCUSSION AND CONCLUSION

Restricting e-cigarette product placement or imagery in music videos may minimize marketing exposure and risk for vaping among young adults, especially among those under the tobacco purchasing age.

Instagram's #JUUL: who's posting what

Exposure to e-cigarette (e-cig) marketing through traditional and online media can increase the risk of e-cig use among adolescents. Though popular e-cig brand JUUL has scaled back its social media promotions, outside vendors and individual users create posts about JUUL unregulated. Instagram's image-focus offers an opportunity to document promotions that may appeal to adolescents. To assess the visual representation of JUUL on social media, we systematically classified discussion topics and themes of posts to Instagram. Of 25,428 unique Instagram images using the hashtag #JUUL retrieved between June 18 and July 18, 2018, a random subsample of 3,000 images (approximately 12% of the full data set) was drawn for human coding and analyses. Coded categories included relevance to JUUL, type of image, image appeal, and user type. Based on the number of relevant images, percentages of image type and appeal for each user type were calculated. There were 583 images that were coded as relevant. The majority of image types (64%) were classified as product (n =; 374). The most frequently coded type of appeal was flavors, found in 54% of images with appeal (n =; 149), followed by cartoons, found in 21% (n =; 57). Vendors were responsible for posting most of the images (n =; 291), followed by e-cig enthusiasts (n =; 99). Continued surveillance of e-cig products, such as JUUL, remains necessary to provide a foundation for potential regulatory protections against marketing and promotions that may appeal to youth.

Instagram Posts Related to Backwoods Cigarillo Blunts: Content Analysis

Background

Instagram, one of the most popular social media platforms among youth, offers a unique opportunity to examine blunts—partially or fully hollowed-out large cigars, little cigars, and cigarillos that are filled with marijuana. Cigarillo brands like Backwoods (Imperial Tobacco Group Brands LLC) have product features that facilitate blunt making, including a variety of brand-specific flavors that enhance the smoking experience (eg, honey, dark stout). Backwoods has an active online presence with a user-friendly website.

Objective

This study examined the extent to which Backwoods cigarillo–related posts on Instagram showed blunt making. Instagram offers a unique opportunity to examine blunt making as Instagram accounts will contain images reflective of behavior occurring without the prime of a researcher.

Methods

Data consisted of publicly available Instagram posts with the hashtag #backwoods collected from August 30 to September 12, 2018. Inclusion criteria for this study included an Instagram post with the hashtag “#backwoods”. Rules were established to content analyze posts. Categories included Type of post (ie, photo, video, or both); Blunt-related hashtags (ie, the corresponding post caption contained one or more hashtags like #blunts, #cannabis, and #weed that were identified in previous social media research); Rolling blunts (ie, the post contained an image of one or more individuals rolling a Backwoods cigarillo visibly containing marijuana); and Smoking blunts (ie, the post contained an image of one or more individuals blowing smoke or holding a lit blunt). We coded images for Product flavor reference, where a code of 1 showed a Backwoods cigarillo pack with a brand-specific flavor (eg, honey, dark stout, Russian crème) visible in the blunt-related image, and a code of 0 indicated that it was not visible anywhere in the image.

Results

Among all posts (N=1206), 871 (72.2%) were coded as Blunt-related hashtags. A total of 125 (10.4%) images were coded as Smoking blunts, and 25 (2.1%) were coded as Rolling blunts (ie, Backwoods cigarillo explicitly used to roll blunts). Among blunt images, 434 of 836 (51.9%) were coded as Product flavor (ie, a Backwoods pack with a brand-specific flavor was visible).

Conclusions

Most Backwoods cigarillo–related Instagram images were blunt-related, and these blunt-related images showed Backwoods packages indicating flavor preference. Continued monitoring and surveillance of blunt-related posts on Instagram is needed to inform policies and interventions that reduce the risk that youth may experiment with blunts. Specific policies could include restrictions on product features (eg, flavors, perforated lines, attractive resealable foil pouches, sale as singles) that facilitate blunt making.

Twitter Posts About Cannabis Use During Pregnancy and Postpartum:A Content Analysis

The prevalence of cannabis use has increased among U.S. pregnant women. Given this increase, and rapidly changing cannabis policies, it may be important to harness digital data sources to help capture trends and perceptions of cannabis use during pregnancy and postpartum. The objective of this study was to examine cannabis and pregnancy-related posts on Twitter over a 12-month period. Methods: Twitter posts from December 1, 2019 to December 1, 2020 that contained pregnancy and cannabis-related keywords were collected in this study (n = 17,238). A sample of 1,000 posts proportionally sampled by week and cannabis/pregnancy-related terms were selected for coding. Posts were classified by one or more of the following themes: 1) Safety during pregnancy i.e. mentions the safety of cannabis use during pregnancy, 2) Safety postpartum i.e. mentions the safety of cannabis use postpartum, and 3) Use for pregnancy-related symptoms i.e. mentions use of cannabis to help with morning sickness, nausea, vomiting, headaches, pain, stress, and fatigue. Results: Safety during pregnancy occurred in 36.00% of the posts and 2.30% posts asked about safety during postpartum. Use of cannabis for pregnancy-related symptoms occurred in 2.70% of posts. Discussion: Findings show that conversations about the risks and benefits of cannabis use during pregnancy and postpartum take place on Twitter. These findings suggests that health practitioners should discuss the risks of cannabis use (including CBD) during pregnancy and breastfeeding with their patients. Health communication planners may need to find ways to communicate risks with the public to prevent the spread of misinformation.

"I'm using cigarettes to quit JUUL": An analysis of Twitter posts about JUUL cessation

INTRODUCTION

JUUL, a small pod-based vaping device that aerosolizes nicotine salts, is popular among adolescents and young adults. Because of JUUL's high nicotine content, JUUL users can become nicotine dependent very quickly and have difficulty quitting. Nicotine-dependent JUUL users might turn to Twitter to seek advice, share their cessation struggles, or report their success rather than confiding in friends or family.

METHOD

This study analyzed Twitter tweets (N = 3192) posted in 2018-2019 to identify common themes about quitting JUUL. Tweets containing the keywords "JUUL" and "quit" or "quitting" were analyzed qualitatively and grouped into themes.

RESULTS

The most common themes were Methods to quit (25.4%), Have quit (17.8%), Want to quit (16.1%), Reasons to quit (9.6%), Difficulty quitting (7.9%), Barriers to quitting (2.9%), and Curious about quitting (2.1%). Methods to quit included evidence-based tobacco cessation methods such as nicotine replacement therapy and enrolling in a text-to-quit program, but they also included non-evidence-based strategies such as buying lower-nicotine pods online or switching to other tobacco products including cigarettes. Former JUUL users who had quit successfully generally expressed pride but also acknowledged that quitting was very difficult. Reasons for quitting included adverse health effects such as breathing problems and the financial cost of a JUUL habit. Posters mentioned their extreme difficulty quitting JUUL, numerous failed quit attempts, and numerous barriers to quitting including intense physical and emotional withdrawal symptoms. Some posters joked about switching to cigarettes or other drugs to quit JUUL.

CONCLUSION

Results indicate that JUUL cessation is difficult and that some JUUL users want to quit. Health communication messages are needed to direct JUUL users to effective cessation strategies.

Content Analysis of Instagram Posts From 2019 With Cartoon-Based Marketing of e-Cigarette-Associated Products

This research study examines the prevalence of cartoon images promoting e-cigarette–associated products on Instagram and their association with likes from users.

Characterizing #Backwoods on Instagram: "The Number One Selling All Natural Cigar"

We sought to assess the proportion of Backwoods (Imperial Tobacco Group Brands LLC) cigar-related posts to Instagram that may contain misleading claims, nature-evoking imagery, and appealing flavors. Inclusion criteria for this study included an Instagram post with the hashtag “#backwoods” from 30 August to 12 September 2018. Rules were established to content analyze (n = 1206) posts. Categories included misleading packaging (i.e., the post contained an image of a Backwoods product with the descriptor “natural” on the packaging), misleading promo (i.e., the corresponding caption to the post contained hashtag(s) like “#natural”, “#authentic”, “#alwaystrue”), nature-evoking imagery (i.e., the post contained images of grass, water, and pastural views along with a Backwoods product), flavors (i.e., the post contained a Backwoods product with brand-specific flavors on the packaging), flavor promo (i.e., the corresponding caption to the post contained hashtag(s) of Backwoods’ brand-specific flavors), marijuana-related (i.e., the post contained an image of marijuana next to a Backwoods pack, rolled cigars visibly contained marijuana, or hollowed-out cigars next to marijuana), smoking (the post contained an image of smoke or a lit cigar), brand-specific promo (i.e., the post contained an image of a Backwoods t-shirt, sweatshirt, hat, etc.), and perceived gender. Among the posts analyzed, 645 (53.5%) were marijuana-related, 564 (46.8%) were flavors, 463 (38.4%) were misleading packaging, 335 (27.8%) were flavor promo, 309 (25.6%) were misleading promo, 188 (15.6%) were nature-evoking imagery, 165 (13.7%) were smoking, 157 (13.0%) were brand-specific promo, and 239 (19.8%) were perceived male gender. Backwoods cigar-related posts to Instagram often contained misleading images and promotions of a “natural” tobacco product, images of marijuana use (in the form of blunt-making), brand-specific flavors, smoking, and promotional merchandise. Misleading images and the depictions of marijuana use in addition to the variety of flavor options may increase product appeal to consumers. These results underscore the need for comprehensive regulation of cigar products similar to cigarettes.

Insights on electronic cigarette products from reviews on the Reddit forum

INTRODUCTION

E-cigarette devices and their component parts are continuously evolving. Little is known about the product design features that may increase the appeal of e-cigarette use, ultimately affecting continuation of use. Product reviews have been described as useful in helping to forecast the popularity of products, and online reviews have become an important channel of product information. This study analyzed e-cigarette product reviews to attempt to arrive at a greater understanding of the features of e-cigarette products that may make them appealing to current users.

METHODS

Data included 248 product reviews found on a popular e-cigarette-related discussion site of Reddit from 10 April 2017 to 12 November 2018. For this study, we examined the sub-sections relating to the positive features (PFs) and negative features (NFs) of the product, found in each review. Common themes were identified and coded.

RESULTS

There were 2929 comments on PFs (average 12 per product), and 1003 on NFs (average 4 per product). Commonly found in the reviews were the ten themes: build quality, color, tip model, battery quality, price, screw quality, power mode performance, coil performance, temperature control performance, and tank quality.

CONCLUSIONS

Findings suggest e-cigarette users expect well-made devices and have developed ways to discriminate between products that perform well from those that do not. Findings suggest that the control of price and design features of e-cigarette products (e.g. color, size, voltage, wattage, coils) warrants consideration for future research and policies addressing e-cigarette use.

Cannabis Surveillance With Twitter Data: Emerging Topics and Social Bots

Objectives. To use publicly accessible data from people who post to Twitter to rapidly capture and describe the public's recent experiences with cannabis.Methods. We obtained Twitter posts containing cannabis-related terms from May 1, 2018, to December 31, 2018. We used methods to distinguish between posts from social bots and nonbots. We used text classifiers to identify topics in posts (n = 60 861).Results. Prevalent topics of posts included using cannabis with mentions of cannabis initiation, processed cannabis products, and health and medical with posts suggesting that cannabis could help with cancer, sleep, pain, anxiety, depression, trauma, and posttraumatic stress disorder. Polysubstance use was a common topic with mentions of cocaine, heroin, ecstasy, LSD, meth, mushrooms, and Xanax along with cannabis. Social bots regularly made health claims about cannabis.Conclusions. Findings suggest that processed cannabis products, unsubstantiated health claims about cannabis products, and the co-use of cannabis with legal and illicit substances warrant considerations by public health researchers in the future.

Do tobacco industry websites target content to specific demographic groups?

BACKGROUND

Prior research has not examined whether tobacco brand websites vary content based on audience demographics. This study explored whether marketing content on tobacco brand websites varied by user ethnicity, gender or age group.

METHODS

Participants (n = 32) were adult smokers, representing equal numbers of eight demographic groups: user ethnicity (Non-Hispanic White, Hispanic, African American, Asian), gender (women, men) and age (age 21-35, age 36+). This study examined 12 tobacco brand websites representing four tobacco product categories (cigarettes, cigar/cigarillos, smokeless tobacco, and e-cigarettes). From January 2016 to January 2017, participants coded websites for themes, interactive activities, and links to social media sites (n = 874 website visits). Logistic regression was used to analyze observed content by participant ethnicity, age and gender.

RESULTS

All themes, all interactive activities and all links to social media were observed at least once for each demographic category. Male participants were more likely to observe Harm reduction themes, while female participants were more likely to observe Promotion themes. Older participants were more likely to observe website features allowing them to select music, and request coupons. Compared to Non-Hispanic White participants, African American participants were more likely to observe links to social media sites.

CONCLUSION

Tobacco brand website content varied across ethnic, age and gender groups. These findings suggest that other factors, such as tobacco use behaviors, may influence marketing strategies participants recall or find appealing. The findings from this study can inform future regulatory activities and communication strategies aimed at countering pro-tobacco content online.

Follow-Up Investigation on the Promotional Practices of Electric Scooter Companies: Content Analysis of Posts on Instagram and Twitter

Background

Electric scooters (e-scooters) have become a popular mode of transportation in both the United States and Europe. In the wake of this popularity, e-scooters have changed the commuting experience in many metropolitan areas. Although e-scooters offer an efficient and economical way to travel short distances in traffic-congested areas, recent studies have raised concerns over their safety. Bird and Tier Mobility are 2 popular e-scooter companies in the United States and Europe, respectively. Both companies maintain active social media accounts with hundreds of posts and tens of thousands of followers. Recent studies have shown that consumer behavior may be influenced by the content posted to popular social media platforms, such as Instagram and Twitter.

Objective

This study aimed to examine the official Instagram and Twitter accounts of Bird and Tier Mobility to determine whether these companies promote and demonstrate the use of safety gear in their posts to their consumers.

Methods

Posts to Bird’s (n=287) and Tier Mobility’s (n=190) official Instagram accounts, as well as Bird’s (n=313) and Tier Mobility’s (n=67) official Twitter accounts, were collected from November 9, 2018, to October 7, 2019. Rules for coding content of posts were informed by previous research.

Results

Among posts to Bird’s Instagram account, 69.3% (199/287) had a person visible with an e-scooter, 9.1% (26/287) contained persons wearing protective gear, and there were no mentions of protective gear in captions corresponding to the post. Among posts to Tier Mobility’s Instagram account, 84.7% (161/190) contained a person visible with an e-scooter, 36.3% (69/190) contained persons wearing protective gear, and 4.2% (8/190) of captions corresponding to posts mentioned protective gear. Among posts to Bird’s Twitter account, 71.9% (225/313) had an image, of which 44.0% (99/225) contained a person visible with an e-scooter and 15.1% (34/225) contained persons wearing protective gear. Among posts to Tier Mobility’s Twitter account, 78% (52/67) had an image, of which 52% (27/52) contained a person with an e-scooter and 21% (11/52) contained persons wearing protective gear.

Conclusions

Findings show that modeling and promoting safety is rare on Bird’s and Tier Mobility’s official social media accounts, which may contribute to the normalization of unsafe riding practices. Social media platforms may offer a potential avenue for public health officials to intervene with rider safety campaigns for public education.

E-liquid-related posts to Twitter in 2018: Thematic analysis

INTRODUCTION

E-liquid is the solution aerosolized by e-cigarette devices to produce vapor. Continuously evolving e-liquids, and corresponding devices, can affect user experiences associated with these products. Twitter conversations about e-liquids can capture salient behavioral, social, and communicative cues associated with e-liquids. We analyzed Twitter data to characterize key topics of conversation about e-liquids to inform surveillance, and regulatory efforts.

METHODS

Twitter posts containing e-liquid-related terms ("e-liquid(s)," "e-juice(s)") were obtained from 1 January 2018 to 31 December 2018. Text classifiers were used to identify topics of the posts (n = 15,927).

RESULTS

The most prevalent topic was Promotional at 29.35% followed by Flavors at 24.22%, and Person Tagging at 21.47%. Juice Composition was next most prevalent at 17.61% followed by Cannabis at 16.83%, and Nicotine Health Risks at 6.39%. Quit Smoking was rare at 0.57%.

CONCLUSION

These results suggest that flavors, cannabis, health risks of nicotine, and composition warrant consideration as targets in future surveillance, public policy, and interventions addressing the use of e-liquids. Twitter provides ample opportunity to influence the normalization, and uptake, of e-cigarette-related products among non-smokers and youth, unless regulatory restrictions, and counter messaging campaigns are developed to reduce this risk.

Monitoring Tobacco Brand Websites to Understand Marketing Strategies Aimed at Tobacco Product Users and Potential Users

Introduction

Limited information exists about strategies and methods used on brand marketing websites to transmit pro-tobacco messages to tobacco users and potential users. This study compared age verification methods, themes, interactive activities and links to social media across tobacco brand websites.

Methods

This study examined 12 tobacco brand websites representing four tobacco product categories: cigarettes, cigar/cigarillos, smokeless tobacco, and e-cigarettes. Website content was analyzed by tobacco product category and data from all website visits (n = 699) were analyzed. Adult smokers (n = 32) coded websites during a one-year period, indicating whether or not they observed any of 53 marketing themes, seven interactive activities, or five external links to social media sites.

Results

Most (58%) websites required online registration before entering, however e-cigarette websites used click-through age verification. Compared to cigarette sites, cigar/cigarillo sites were more likely to feature themes related to "party" lifestyle, and e-cigarette websites were much more likely to feature themes related to harm reduction. Cigarette sites featured greater levels of interactive content compared to other tobacco products. Compared to cigarette sites, cigar/cigarillo sites were more likely to feature activities related to events and music. Compared to cigarette sites, both cigar and e-cigarette sites were more likely to direct visitors to external social media sites.

Conclusion

Marketing methods and strategies normalize tobacco use by providing website visitors with positive themes combined with interactive content, and is an area of future research. Moreover, all tobacco products under federal regulatory authority should be required to use more stringent age verification gates.

Implications

Findings indicate that the Food and Drug Administration (FDA) should require brand websites of all tobacco products under its regulatory authority use more stringent age verification gates by requiring all visitors be at least 18 years of age and register online prior to entry. This is important given that marketing strategies may encourage experimentation with tobacco or deter quit attempts among website visitors. Future research should examine the use of interactive activities and social media on a wide variety of tobacco brand websites as interactive content is associated with more active information processing.

Cartoon-based e-cigarette marketing: Associations with susceptibility to use and perceived expectations of use

BACKGROUND

Manufacturers of e-cigarette-related products are using cartoons as a marketing strategy, despite restrictions on cartoon marketing for combustible cigarettes. Here, we examined associations between exposure to e-liquid packaging with cartoons (operationally defined as recognition of actual marketing images) and e-cigarette use, susceptibility to use, and expectations of benefits and risks of use.

METHODS

U.S. adults completed online surveys assessing e-cigarette use. In Study 1, participants (N = 778; Mean age = 23.5 years; 62% women) completed a questionnaire assessing expectations about benefits and risks of use. Then they were presented with 22 e-liquid package images (with and without cartoons) and were asked to endorse whether they recognized the products. In Study 2, participants (N = 522; Mean age = 30.4; 55% women) were presented with 24 e-liquid images (with and without cartoons) and asked to rate product appeal.

RESULTS

For Study 1, among never users, cartoon recognition was associated with greater likelihood of being susceptible to use e-cigarettes, and with expectations of taste enjoyment and social facilitation. For Study 2, there was no significant difference between cartoon and non-cartoon images on appeal ratings.

CONCLUSIONS

Cartoon-based marketing exposure - as measured by recognition of e-liquid package images - was associated with susceptibility to use e-cigarettes, which is consistent with previous research on the use of cartoons to promote combustible cigarettes. These data suggest that restrictions on the use of cartoon-based marketing strategies for e-cigarettes should be similar to those for cigarettes, to reduce susceptibility and perceived benefits among non-users.

Characterizing Swisher Little Cigar-Related Posts on Twitter in 2018: Text Analysis

Background

Little cigars are growing in popularity in the United States, and Swisher is the market leader. The contexts and experiences associated with the use of Swisher-related products is understudied, but such information is available via publicly available posts on Twitter.

Objective

This study aimed to analyze Twitter posts to characterize Twitter users’ recent experiences with Swisher-related products.

Methods

Twitter posts containing the term “swisher” were analyzed from January 1, 2018, to December 31, 2018. Text classifiers were used to identify topics in posts (n=81,333).

Results

The most prevalent topic was Person Tagging (mentioning a Twitter account in a post; 32.77%), followed by Flavors (eg, Grape and Strawberry; 20.96%) and Swisher use (eg, smoke swisher; 17.44%). Additional topics included Cannabis use (eg, blunt, roll, and gut swisher; 6.26%), Appeal (eg, like Swisher; 5.92%), Dislike (eg, posts that showed dissatisfaction with Swisher products; 3.53%), Purchases (eg, buy swisher; 1.90%), and Cigar comparison (eg, mentions of other cigar products including White-owl and Backwoods; 1.64%).

Conclusions

This paper describes common contexts and experiences associated with the use of Swisher little cigars from the population posting on Twitter in 2018. These online messages may have offline consequences for tobacco-related behaviors, indicating the need for countering from public health officials. Findings should inform us about targets for surveillance, policy, and interventions addressing Swisher little cigars as well as communication planning and tobacco product counter messaging on Twitter.