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.

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.

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).

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.

Themes in TikTok Videos Featuring Little Cigars and Cigarillos: Content Analysis.

BACKGROUND: Little cigars and cigarillos (LCCs) are popular tobacco products among youth (ie, adolescents and young adults). A variety of LCC-related promotional and user-generated content is present on social media. However, research on LCC-related posts on social media has been largely focused on platforms that are primarily text- or image-based, such as Twitter and Instagram. OBJECTIVE: This study analyzed LCC-related content on TikTok, an audio and video-based platform popular among youth. METHODS: Publicly available posts (N=811) that contained the LCC-related hashtags #swishersweets or #backwoods were collected on TikTok from January 2019 to May 2021. Metadata were also collected, including numbers of likes, comments, shares, and views per video. Using an inductive approach, a codebook consisting of 26 themes was developed to help summarize the underlying themes evident in the TikTok videos and corresponding captions. A pairwise co-occurrence analysis of themes was also conducted to evaluate connections among themes. RESULTS: Among the 811 posts, the LCC presence theme (ie, a visible LCC) occurred in the most prominent number of posts (n=661, 81.5%), followed by music (n=559, 68.9%), youth (n=332, 40.9%), humor (n=263, 32.4%), LCC use (n=242, 29.8%), flavors (n=232, 28.6%), branding (n=182, 22.4%), paraphernalia (n=137, 16.9%), blunt rolling (n=94, 11.6%), and price (n=84, 10.4%). Product reviews had the highest engagement, with a median 44 (mean 2857, range 36,499) likes and median 491 (mean 15,711, range 193,590) views; followed by product comparisons, with a median 44 (mean 1920, range 36,500) likes and median 671 (mean 11,277, range 193,798) views. Promotions had the lowest engagement, with a median 4 (mean 8, range 34) likes and median 78 (mean 213, range 1131) views. The most prevalent themes co-occurring with LCC presence were (1) music (434/811, 53.5%), (2) youth (264/811, 32.6%), (3) humor (219/811, 27%), (4) flavors (214/811, 26.4%), and (5) LCC use (207/811, 25.5%). CONCLUSIONS: LCC-related marketing and user-generated content was present on TikTok, including videos showing youth discussing, displaying, or using LCCs. Such content may be in violation of TikTok's community guidelines prohibiting the display, promotion, or posting of tobacco-related content on its platform, including the display of possession or consumption of tobacco by a minor. Further improvement in the enforcement of TikTok community guidelines and additional scrutiny from public health policy makers may be necessary for protecting youth from future exposure to tobacco-related posts. Observational and experimental studies are needed to understand the impact of exposure to LCC-related videos on attitudes and behaviors related to LCC use among youth. Finally, there may be a need for engaging antitobacco videos that appeal to youth on TikTok to counter the protobacco content on this platform.

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

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.

Identifying Health-Related Discussions of Cannabis Use on Twitter by Using a Medical Dictionary: Content Analysis of Tweets.

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.

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.

Adherence to clinical follow-up recommendations for liver function tests: A cross-sectional study of patients with HCV and their associated risk behaviors.

This study examined whether patients with Hepatitis C virus (HCV) infection adhered to their physicians' recommendation and HCV clinical guidelines for obtaining a regular liver function test (LFT), and whether high-risk behaviors are associated with behavioral adherence. A cross-sectional survey was administered to 101 eligible patients with HCV who were recruited from health centers in New Jersey and Washington, DC. Adherence outcomes were defined as the patients' self-report of two consecutive receipts of LFTs in accordance with their physicians' recommended interval or the clinical guidelines for a LFT within 3-6 months. 67.4% of patients (66/98) reported a receipt of their physicians' recommendation for a LFT. The rate of adherence to physician recommendation was about 70% (46/66), however over 50% (52/101) of patients with HCV did not obtain regular LFTs. 15.8% (16/101) of patients continued to use injection drugs. Patients who used injection drugs had 0.87 (adjusted odds ratio (aOR) = 0.13, 95% confidence interval 0.03-0.59) times lower odds adhering to their physician recommendation, relative to non-users. Patients with HIV co-infection had increased odds of adhering to the clinical guidelines (odds ratio 3.41, 95% confidence interval 1.34-8.70) vs. patients who did not report HIV co-infection. Additionally, patients who had received a physician's recommendation had 7.21 times (95% confidence interval of 2.36-22.2) greater odds adhering to the clinical guidelines than those who had not. Overall, promoting HCV patient-provider communication regarding regular LFTs and reduction of risk behaviors is essential for preventing patients from HCV-related liver disease progression.

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

BACKGROUND: 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.

#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.

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.