Marijuana Promotion Online: an Investigation of Dispensary Practices.

Marijuana product advertising will become more common, as the use of medical and/or recreational marijuana becomes increasingly legal in the USA. In this study, we investigate the marketing tactics being used on marijuana dispensary websites in the USA that could influence substance use behaviors. One hundred dispensary websites were randomly selected from 10 states that allowed the legal use of medical or recreational marijuana and had at least 10 operational dispensaries. Three dispensaries were excluded due to non-functioning websites, leaving a sample of 97 dispensaries. Content analysis was conducted on these dispensaries' websites, with the primary areas of focus including website age verification, marijuana effects, warnings, and promotional tactics. Among the 97 dispensaries, 75% did not include age verification. Roughly 30% offered online ordering and 21% offered delivery services. Sixty-seven percent made health claims pertaining to medical conditions that could be treated by their marijuana products, with moderate or conclusive evidence to support their claims. Less than half of the dispensaries (45%) advised consumers of possible side effects, and only 18% included warnings about contraindications. Nearly half (44%) offered reduced prices or coupons, 19% offered "buy one get one free" offers, and 16% provided giveaways or free samples. Our findings indicate that marijuana dispensary websites are easily accessible to youth. In addition, only a small amount of the websites advised consumers about possible side effects or contraindications. This study suggests the need for surveillance of marijuana commercialization and online advertising especially in the context of state policy reforms.

Leveraging user perspectives for insight into cannabis concentrates.

BACKGROUND: The US has seen an increase in the popularity of highly concentrated forms of cannabis (hereafter concentrates) and too little is known about the potential risks associated with their use. OBJECTIVES: The present study aims to better understand the patterns and outcomes of concentrates use through the perspectives of young adult users. METHODS: Participants (N = 234, 27.9% female) aged 18-35 years were recruited using SurveyMonkey Audience® and had ingested concentrates at least once in the past 6 months. They were queried on concentrates use patterns (e.g., frequency, medical/recreational) and the effects experienced after using concentrates (e.g., physiological/psychological, strength/duration). RESULTS: A total of 27.8% of participants reported frequent use of concentrates (≥10 days in past month). Those who used for medical purposes or lived in states where use is legal were more likely to use concentrates frequently. While most (64.2%) did not report experiencing potentially serious side effects, some reported a sense of altered reality/confusion (23.3%), rapid heartbeat (11.2%), lung pain (9.9%) and severe paranoia (6.9%). Among those who used concentrates in the past month (N = 168), 72.6% used concentrates with other cannabis forms, 57.7% used along with alcohol, and 22.6% used with other drugs. CONCLUSION: Continued research on concentrates use in the US is needed. Research-informed policies that foster safe and responsible use of concentrates are necessary to protect users, especially those who use concentrates frequently, from potential negative side effects.

A content analysis of an online pro-eating disorder community on Reddit.

Pro-eating disorder communities provide a refuge for individuals with eating disorders (EDs) who are ambivalent about seeking treatment. We investigated a pro-ED community on Reddit, an anonymous social networking platform with topical forums, to identify expression of behaviors aligned with ED symptoms and support for these behaviors. A content analysis on four weeks of topic-specific discussion threads (N=125 comments, 115 replies to comments) was conducted to identify behaviors consistent with ED psychopathology and support for these behaviors (informational, tangible assistance, esteem/emotional support). Results indicated that the content aligned with expressions of clinically relevant ED psychopathology, with eating concerns (49/125) and shape concerns (47/125) being most prevalent. The majority (92/115) of replies provided esteem/emotional support to the comment author. Online interventions and/or recovery programs are needed to counteract reinforcing dialogue that occurs on social media sites, like Reddit, and promote ED recovery through supportive messages on these platforms.

Operating a motor vehicle after marijuana use: Perspectives from people who use high-potency marijuana.

BACKGROUND: With advancing marijuana legalization in the United States, a primary concern is the possible increase in consequences relating to marijuana driving impairment, especially among people who use high-potency marijuana (i.e., extracts). In this study, the research team assessed the risk perception and experiences of driving under the influence of marijuana by investigating people who use extracts. METHODS: Participants from 2 studies were queried about driving after using marijuana. In Study 1, phone interviews (n = 19) were conducted with people who use extracts. In Study 2, people who use extracts (n = 174) were recruited to participate in a nationwide survey via an online existing panel. Responses to marijuana and driving-related questions were qualitatively coded for themes (e.g., riskiness, engagement in behavior) developed by the research team. RESULTS: Prominent themes identified in Study 1 suggested a belief that driving risk following marijuana use is dependent on the individual (i.e., response/tolerance) or the amount/type of marijuana consumed. This theme was corroborated by Study 2 participants. Those who perceived no or minimal risk from driving following marijuana use were more likely to report engagement in driving following extracts use. CONCLUSIONS: More research is needed to understand how marijuana, especially in its concentrated form, impacts driving ability in order to develop appropriate and scientifically sound regulations. Such research could subsequently fill the need to improve and more widely disseminate prevention messages on marijuana use and driving risks.

"No High Like a Brownie High": A Content Analysis of Edible Marijuana Tweets.

PURPOSE: To investigate tweets about marijuana edibles for surveillance into the content of edibles-related tweets among individuals socially networking about this topic on Twitter. DESIGN: Cross-sectional analysis of tweets containing edible marijuana-related key words during 1 month. SETTING: Twitter. PARTICIPANTS: Tweets sent during January 1 to 31, 2015. METHODS: A random sample of 5000 tweets containing edibles-related key words was coded for sentiment (positive, negative, and neutral) by crowdsourced workers. Tweets normalizing or promoting edibles use were further analyzed, and demographic characteristics of the Twitter handles sending these tweets were inferred. RESULTS: Of the 5000 tweets, 4166 (83%) were about marijuana edibles, and of those 75% (3134 of 4166) normalized or encouraged edibles use. Nearly half (48%, 1509 of 3134) of the tweets normalizing edibles mentioned wanting or planning to consume, currently consuming, or recently consuming edibles, and 12% (378 of 3134) described the intense or long-lasting effects following use. Individuals whose tweets promoted/encouraged edibles use were more likely to be young (between 17 and 24 years old) and of a racial/ethnic minority (52% black; 12% Hispanic) when compared to the Twitter average. CONCLUSION: Tweets that normalize edibles use have the potential to increase their popularity. The prevalence of tweets about edibles' intense high could have implications for tailoring prevention messages that could be important for youth and young adult minorities who were inferred to be disproportionately socially networking about edibles on Twitter.

Exposure to and Content of Marijuana Product Reviews.

Many individuals now seek out product reviews in order to make an informed decision prior to making a purchase. In this study, we investigate consumers' exposure to and content within product reviews about marijuana because of their potential to shape marijuana purchasing decisions. The terms "weed review," "marijuana review," and "cannabis review" were searched on YouTube on June 10-11, 2015; the team viewed and coded the content of 83 product review videos about marijuana. In addition, we surveyed young adult (18-34 years old) current (past month) marijuana users (n = 742) from across the USA online to assess exposure to product reviews about marijuana and associations with socio-demographic characteristics and marijuana use behaviors. In our content analysis of videos, we observed that the reviewers tended to consume marijuana during the video and often shared personal, favorable experiences towards the marijuana they ingested (e.g., became as high as possible or experienced positive effects on physical and mental health). Most videos normalized marijuana use and could be easily accessed by underage youth. About one third (34%) of the survey participants viewed/sought a product review about marijuana in the past 30 days. In a multivariable logistic regression model, living in a state where recreational use is legal or using multiple forms of marijuana was associated with increased odds of viewing/seeking marijuana reviews. Prevention messages should counter product reviews about marijuana that tend to normalize and promote marijuana use given that they are more readily viewed by individuals who are increasingly susceptible to marijuana's potential harms.

Social networking online to recover from opioid use disorder: A study of community interactions.

BACKGROUND: Social media has increasingly become a venue for health discourse and support, particularly for vulnerable individuals. This study examines user-generated content of an online Reddit community targeting individuals recovering from opiate addiction. METHODS: 100 Reddit posts and their comments were collected from the online community on August 19, 2016. Posts were qualitatively coded for opioid use disorder (OUD) criteria as outlined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as well as other common themes. Comments were coded for expression of distinct therapeutic factors (i.e., instillation of hope, universality, imparting information, and altruism). All posts and comments were coded for addiction phase of the author (i.e., using, withdrawing, recovering). RESULTS: 73 unique usernames authored the 100 posts. Among the 73 usernames, 33% (24/73) described enough symptoms in their posts to meet DSM-V criteria for OUD (16/73 or 22% mild severity, 7/73 or 10% moderate severity, and 1/73 or 1% high severity. Among the 100 posts, advice was requested in 43% (43/100) of the posts and support was sought in 24% (24/100) of the posts. There were 511 comments made on the 100 posts, nearly all of which contained at least one distinct therapeutic factor (486/511, 95%) with altruism being the most common (341/511, 67%). CONCLUSIONS: This research provides validity to the supportive content generated on an online recovery-oriented community, while also revealing discussions of self-reported struggles with OUD among group members. Future research should explore the feasibility of incorporating social media-based peer support into traditional addiction treatments.

"I feel like I've hit the bottom and have no idea what to do": Supportive social networking on Reddit for individuals with a desire to quit cannabis use.

BACKGROUND: Online communities can provide social support to those in need and can foster personal empowerment for individuals experiencing distress. This study examines the content of a Reddit community dedicated to the support of people trying to quit using cannabis, in order to develop an understanding of the type of social networking occurring on this subreddit (e.g., community). METHODS: A total of 100 Reddit posts and their replies (i.e., comments) were collected from the subreddit on June 12, 2015. Posts were qualitatively coded for expression of DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) symptoms of cannabis use disorder (CUD) as well as other prominently featured themes. Comments on posts where individuals were seeking support/advice were also coded. RESULTS: Ninety-one people posted the 100 Reddit posts, and of those 35 (38%) people described enough symptoms to be classified as mild disorder severity, 15 (16%) moderate, and 11 (12%) severe, as outlined in the diagnostic criteria for CUD. Over half of posts (n = 51) were seeking advice and/or support from members of the community. There were 174 comments made by 108 unique people on the advice/support seeking posts. Most were supportive/encouraging in nature (140, 80%) and gave advice to the post author (126, 72%). CONCLUSIONS: This exploratory research highlights the potential of online communities as tools for individuals coping with addiction recovery, and future research should investigate if involvement in such communities would be a beneficial supplement to more traditional recovery practices.

A latent class analysis of poly-marijuana use among young adults.

INTRODUCTION: With more states legalizing marijuana use, the marijuana industry has grown, introducing a variety of marijuana products. Our study explores the use of multiple marijuana products (poly-marijuana use) and the characteristics associated with this behavior. METHODS: Past-month marijuana users aged 18-34years were surveyed online via an existing online panel (n=2444). Participants answered questions about past-month use of three types of marijuana (plant-based, concentrates, edibles), marijuana use patterns, and driving after use. Latent class analysis was used to identify subgroups of marijuana users. RESULTS: Four classes of marijuana users were identified: Light plant users, who used only plant-based products infrequently and were unlikely to drive after use (32%); Heavy plant users, who used mainly plant-based products frequently, multiple times per day, and were likely to drive after use (37%); Plant and concentrates users, who used plant-based products heavily and concentrates at least infrequently, used multiple times per day, and were likely to drive after use (20%); Light plant and edibles users, who used both products infrequently and were unlikely to drive after use (10%). Those in legal marijuana states were more likely to belong to the poly-marijuana groups. DISCUSSION: Our findings reflect the increase in popularity of new marijuana products in legal states and suggest that heavy user groups, including concentrates users, are associated with driving after use. As various forms of marijuana use increases, monitoring and surveillance of the use of multiple types of marijuana will be important for determining potential varying impacts on physiological and social consequences.

Marijuana advertising exposure among current marijuana users in the U.S.

BACKGROUND: Little is known about marijuana advertising exposure among users in the U.S. We examined the prevalence of advertising exposure among young adult marijuana users through traditional and new media, and identified characteristics associated with seeking advertisements. METHODS: We conducted a cross-sectional survey of 18-34 year-old past-month marijuana users in the U.S. using a pre-existing online panel (N=742). The survey queried about passively viewing and actively seeking marijuana advertisements in the past month, sources of advertisements, and marijuana use characteristics. RESULTS: Over half of participants were exposed to marijuana advertising in the past month (28% passively observed advertisements, 26% actively sought advertisements). Common sources for observing advertisements were digital media (i.e., social media, online, text/emails; 77%). Similarly, those actively seeking advertisements often used Internet search engines (65%) and social media (53%). Seeking advertisements was more common among those who used medically (41% medical only, 36% medical and recreational) than recreational users (18%), who used concentrates or edibles (44% and 43%) compared to those who did not (20% and 19%), and who used multiple times per day (33%) compared to those who did not (19%) (all p<0.01). CONCLUSIONS: Exposure to marijuana advertising among users is common, especially via digital media, and is associated with medical use, heavier use, and use of novel products with higher THC concentrations (i.e., concentrates) or longer intoxication duration (i.e., edibles). As the U.S. marijuana policy landscape changes, it will be important to examine potential causal associations between advertising exposure and continuation or frequency/quantity of use.

"It Takes Longer, but When It Hits You It Hits You!": Videos About Marijuana Edibles on YouTube.

BACKGROUND: Interest in marijuana edibles has increased as perceptions of harm from marijuana have decreased. Media and peer influences impact youth substance use, and YouTube is the most popular video-sharing website. No studies have examined the content and accessibility of YouTube videos related to marijuana edibles. OBJECTIVES: To describe the messages conveyed to viewers in YouTube videos about edibles and determine their accessibility to youth. METHODS: On June 12, 2015, we searched YouTube for videos about marijuana/cannabis/weed edibles. A total of 51 videos were coded for presence of an age restriction, purpose(s) of the videos, consumption of edibles during the video, effects, and safety concerns. RESULTS: Total views across all 51 videos were >9 million. Only 14% (7/51) were restricted to viewers over the age of 18 years. Over half (27/51, 53%) were informative videos, most (20/27, 74%) teaching how to make edibles, and 37% (19/51) were entertaining videos. Someone consumed an edible in 31% (16/51) of the videos, and the type of high was mentioned in 51% (26/51) of the videos, including delayed (18/26, 69%) or intense high (13/26, 50%). Fifty-five percent (28/51) mentioned delta-9-tetrahydrocannabinol potency or dosage. Only 10 of these (36%) presented this information specifically as a warning to prevent adverse effects. Conclusions/Importance: Edibles-related videos are easily found on YouTube, often instructing how to bake your own edibles and lacking information needed for safe consumption, and most are not age-restricted. Videos showing how to make edibles or presenting edibles use in an entertaining way that could influence youth to initiate use.

An Analysis of Depression, Self-Harm, and Suicidal Ideation Content on Tumblr.

BACKGROUND: Social networking about depression can be indicative of self-reported depression and/or can normalize risk behaviors such as self-harm and suicidal ideation. AIM: To gain a better understanding of the depression, self-harm, and suicidal content that is being shared on Tumblr. METHOD: From April 16 to May 10, 2014, 17 popular depression-related Tumblr accounts were monitored for new posts and engagement with other Tumblr users. A total of 3,360 posts were randomly selected from all historical posts from these accounts and coded based on themes ascertained by the research team. RESULTS: The 17 Tumblr accounts posted a median number of 185 posts (range = 0-2,954). Content was engaged with (i.e., re-blogged or liked) a median number of 1,677,362 times (range = 0-122,186,504). Of the 3,360 randomly selected posts, 2,739 (82%) were related to depression, suicide, or self-harm. Common themes were self-loathing (412, 15%), loneliness/feeling unloved (405, 15%), self-harm (407, 15%), and suicide (372, 14%). CONCLUSION: This study takes an important first step at better understanding the displayed depression-related references on Tumblr. The findings signal a need for suicide prevention efforts to intervene on Tumblr and use this platform in a strategic way, given the depression and suicidal content that was readily observed on Tumblr.

Exploring Marijuana Advertising on Weedmaps, a Popular Online Directory.

With an increase in the legalization of recreational marijuana across the USA, advertising for marijuana products is more widespread, especially on the Internet where such practices pose a regulatory challenge. In this study, we examined the content of marijuana advertising on Weedmaps, a popular website that markets marijuana retailers online. A total of 146 recreational marijuana retailers in Colorado and Washington were examined on Weedmaps. We studied the age verification practices made in retailers' own websites, the presence of health claims they made about marijuana on Weedmaps, and the characteristics of followers of Weedmaps on social media sites. Many retailers had no security measure to determine age (41 % in Colorado, 35 % in Washington). Approximately 61 % of retailers in Colorado and 44 % in Washington made health claims about the benefits of marijuana, including anxiety reduction, treatment of depression, insomnia, and pain/inflammation. Inferred demographic characteristics of followers of Weedmaps on Twitter and Instagram revealed that over 60 % were male and nearly 70 % or more were age 20-29 years old, yet some (15-18 %) were under the age of 20. Our findings indicate that marijuana retailers have a visible presence on the Internet. Potential customers might be enticed by retailers who tout health claims about marijuana use. It may also be appealing for a younger demographic to overlook age restrictions and engage with marijuana retailers via social media. As a whole, our findings can help to guide future policy making on the issue of marijuana-related advertising.

A Content Analysis of Vaping Advertisements on Twitter, November 2014.

INTRODUCTION: Vaping has increased in popularity, and the potential harms and benefits are largely unknown. Vaping-related advertising is expected to grow as the vaping industry grows; people are exposed primarily to vaping advertisements on the Internet, and Twitter is an especially popular social medium among young people. The primary objective of our study was to describe the characteristics of vaping-related advertisements on Twitter. METHODS: We collected data on 403,079 English-language tweets that appeared during November 2014 and contained vaping-related keywords. Using crowdsourcing services, we identified vaping-related advertisements in a random sample of 5,000 tweets. The advertisement tweets were qualitatively coded for popular marketing tactics by our research team. We also inferred the demographic characteristics of followers of 4 Twitter handles that advertised various novel vape products. RESULTS: The random sample of 5,000 vaping-related tweets included 1,156 (23%) advertisement tweets that were further analyzed. Vape pens were advertised in nearly half of the advertisement tweets (47%), followed by e-juice (21%), which commonly mentioned flavors (42%). Coupons or price discounts were frequently observed (32%); only 3% of tweets mentioned vaping as a way to quit smoking or as an alternative to smoking. One handle had a disproportionately high percentage of racial/ethnic minority followers. CONCLUSION: Vaping poses a threat to smoking prevention progress, and it is important for those in tobacco control to understand and counter the tactics used by vaping companies to entice their consumers, especially on social media where young people can easily view the content.

A content analysis of tweets about high-potency marijuana.

INTRODUCTION: "Dabbing" involves heating extremely concentrated forms of marijuana to high temperatures and inhaling the resulting vapor. We studied themes describing the consequences of using highly concentrated marijuana by examining the dabbing-related content on Twitter. METHODS: Tweets containing dabbing-related keywords were collected from 1/1-1/31/2015 (n=206,854). A random sample of 5000 tweets was coded for content according to pre-determined categories about dabbing-related behaviors and effects experienced using a crowdsourcing service. An examination of tweets from the full sample about respiratory effects and passing out was then conducted by selecting tweets with relevant keywords. RESULTS: Among the 5000 randomly sampled tweets, 3540 (71%) were related to dabbing marijuana concentrates. The most common themes included mentioning current use of concentrates (n=849; 24%), the intense high and/or extreme effects from dabbing (n=763; 22%) and excessive/heavy dabbing (n=517; 15%). Extreme effects included both physiological (n=124/333; 37%) and psychological effects (n=55/333; 17%). The most common physiologic effects, passing out (n=46/333; 14%) and respiratory effects (n=30/333; 9%), were then further studied in the full sample of tweets. Coughing was the most common respiratory effect mentioned (n=807/1179; 68%), and tweeters commonly expressed dabbing with intentions to pass out (416/915; 45%). CONCLUSIONS: This study adds to the limited understanding of marijuana concentrates and highlights self-reported physical and psychological effects from this type of marijuana use. Future research should further examine these effects and the potential severity of health consequences associated with concentrates.

Marijuana-Related Posts on Instagram.

Instagram is a highly visual social networking site whose audience continues to grow, especially among young adults. In the present study, we examine marijuana-related content on Instagram to better understand the varied types of marijuana-related social networking occurring on this popular social media platform. We collected 417,561 Instagram posts with marijuana-related hashtags from November 29 to December 12, 2014. We assessed content of a random sample (n = 5000) of these posts with marijuana-related hashtags. Approximately 2136 (43 %) were explicit about marijuana and further analyzed. Of the 2136 marijuana-related posts, images of marijuana were common (n = 1568). Among these 1568 marijuana images, traditional forms (i.e., buds/leaves) were the most common (63 %), followed by some novel forms of marijuana, including marijuana concentrates (20 %). Among the 568 posts that displayed marijuana being ingested, 20 % showed someone dabbing marijuana concentrates. Marijuana-related advertisements were also observed among the 2136 marijuana-related posts (9 %). Our findings signal the promotion of marijuana use in its traditional plant-based form; trendy and novel modes of marijuana ingestion were also endorsed. This content along with the explicit marketing of marijuana that we observed on Instagram have potential to influence social norms surrounding marijuana use.

Selected State Policies and Associations With Alcohol Use Behaviors and Risky Driving Behaviors Among Youth: Findings from Monitoring the Future Study.

BACKGROUND: Effective policies that can reduce alcohol use behaviors and impaired driving among young people at a population level are needed. Graduated driver licensing (GDL) laws increase the driving privileges of young novice drivers as they age and gain more driving experience. In this study, we seek to determine the effects of GDLs on risky driving behaviors of youth and to assess if GDLs have an unintended effect on underage drinking behaviors. METHODS: We utilized 2000 to 2013 data on 12th grade students from the Monitoring the Future (MTF) study, an ongoing, annual national survey (since 1975) that studies the substance use behaviors of adolescents, as well as data on GDL laws obtained via the Insurance Institute for Highway Safety (IIHS). We conducted a series of regular logistic regression models that included fixed effects for year and state, and adjusted for demographic characteristics, school characteristics, and other state alcohol policies. RESULTS: Total weighted sample size was 129,289 12th graders. Past month alcohol use and binge drinking (i.e., ≥5 drinks on one occasion) in the past 2 weeks were 45 and 26%, respectively. Seventeen percent of respondents reported riding with a driver who drank alcohol. Nearly 12% reported driving in the past 2 weeks after drinking alcohol, and 7% reported driving after binge drinking. Over half of the students lived in a state with a "good" GDL law. The logistic regression models suggest a link between restrictive GDL policies and a reduction of alcohol use behaviors and risky driving behaviors among youth. CONCLUSIONS: Our findings indicate that the effects of GDLs extend beyond driving-related risks and into other drinking-related behaviors that pose immediate or delayed health risks for young people. We speculate that GDLs may dictate social norms and expectations for youth risk behaviors, and should be maximized throughout the United States.

Multiple Levels of Influence That Impact Youth Tobacco Use.

OBJECTIVE: Multiple levels of influence interplay to impact youth tobacco use. We work towards understanding important policy and environmental strategies that are associated with youth tobacco use behaviors. METHODS: We utilized data from participants of the Monitoring the Future (MTF) study and linked national data from multiple sources to assess correlates of youth tobacco use behaviors across individual, family, school, community, and state-level policy influences. RESULTS: Higher cigarette prices had the strongest association with youth tobacco use behaviors. Demographic and socio-economic characteristics at the individual, familial, and community/school-levels were associated with youth tobacco use behaviors. CONCLUSIONS: In the present study, we confirm that higher cigarette prices could help to reduce youth tobacco use behaviors. Several states are still lagging behind in terms of their low cigarette tax and they should enact tax policies to reduce youth tobacco use.

Displays of dabbing marijuana extracts on YouTube.

BACKGROUND: Dabbing involves heating marijuana extracts to a high temperature and inhaling the vapor. Little is known about this new method of using marijuana. YouTube, the most popular platform for sharing online videos, may be a go-to resource for individuals interested in learning about dabbing. Our objective was to explore the content of dabbing-related videos on YouTube. METHODS: We searched for dabbing-related videos on YouTube using the search terms "dabbing" and "dabs" on January 22, 2015. For each term, videos were sorted by relevance and view count. A sample of 116 dabbing videos were viewed and coded for content. RESULTS: The 116 videos (published by 75 unique channels) had a total of 9,545,482 views. Most (76%) of the channels had a specific focus on marijuana and 23% were located in California. Eighty-nine percent of the videos showed at least one person dabbing, and 61% of these showed someone dabbing repeatedly. Most dabbers were male (67%) and many appeared to be >25 years old (42%). Approximately 34% of the videos contained a product review, 28% provided instructions on dabbing or other educational information, and 21% contained at least a brief cautionary message. Over half (54%) of the videos referenced medical marijuana, and only 20% of the videos had an age-restriction. CONCLUSIONS: Dabbing-related videos are easily found and can be readily viewed on YouTube. As marijuana use becomes more accepted by the general population, the popularity of dabbing-related videos could increase, potentially normalizing this potent form of marijuana use.

Hookah-Related Twitter Chatter: A Content Analysis.

INTRODUCTION: Hookah smoking is becoming increasingly popular among young adults and is often perceived as less harmful than cigarette use. Prior studies show that it is common for youth and young adults to network about substance use behaviors on social media. Social media messages about hookah could influence its use among young people. We explored normalization or discouragement of hookah smoking, and other common messages about hookah on Twitter. METHODS: From the full stream of tweets posted on Twitter from April 12, 2014, to May 10, 2014 (approximately 14.5 billion tweets), all tweets containing the terms hookah, hooka, shisha, or sheesha were collected (n = 358,523). The hookah tweets from Twitter users (tweeters) with high influence and followers were identified (n = 39,824) and a random sample of 5,000 tweets was taken (13% of tweets with high influence and followers). The sample of tweets was qualitatively coded for normalization (ie, makes hookah smoking seem common and normal or portrays positive experiences with smoking hookah) or discouragement of hookah smoking, and other common themes using crowdsourcing. RESULTS: Approximately 87% of the sample of tweets normalized hookah use, and 7% were against hookah or discouraged its use. Nearly half (46%) of tweets that normalized hookah indicated that the tweeter was smoking hookah or wanted to smoke hookah, and 19% were advertisements/promotions for hookah bars or products. CONCLUSION: Educational campaigns about health harms from hookah use and policy changes regarding smoke-free air laws and tobacco advertising on the Internet may be useful to help offset the influence of pro-hookah messages seen on social media.