ABSTRACT
This mixed-methods study analyzed English language US-based Twitter posts related to e-cigarette use from February 2021. Posts were manually identified as health-related or not, and if health-related, whether they were posted by an e-cigarette user. A random selection of 1,000 health-related tweets from 986 unique e-cigarette users were qualitatively content-analyzed for theory of planned behavior (TPB) constructs, as well as nature and tone of each tweet message. Using quantitative semantic network analysis, relationships among the identified topics and sentiment-specific conversation patterns were explored. The most salient health-related conversation topics of e-cigarette users, health beliefs corresponding to each TPB construct, and major motivational contexts of e-cigarette use were identified. Seven topics emerged in positive tweets: smoking cessation, social impact generation, controls over addiction, therapeutic effects on physical and mental health, social support, device attachment, and peer influence. Nine topics emerged in negative tweets: side effects on physical health, vaping addiction, lack of e-cigarette regulations, peer pressure, increased risk of COVID-19, side effects on mental health, no help in smoking cessation, social conflict, and polysubstance use. Most assertions for e-cigarette benefits were not substantiated. Jokes in tweets appeared to contribute to the view of vaping as an attractive, enjoyable, safe, and fun activity. Discussions about positive aspects of e-cigarette use were concentrated on a few related topics, while tweets discouraging e-cigarette use presented a diverse, less related topics. The results provide insights into drivers of e-cigarette use behaviors. E-cigarette user perspectives gathered from social media may inform research to guide future prevention and cessation interventions.