Reduced harm or another gateway to smoking? source, message, and information characteristics of E-cigarette videos on YouTube

Understanding the Associations Between Adolescents' Exposure to E-Cigarette Information and Vaping Behavior Through the Theory of Planned Behavior

Adolescents have actively looked for and passively scanned information about electronic cigarettes (e-cigarettes) from a variety of media and interpersonal sources. Despite the evidence that exposure to e-cigarette information is associated with youth's increased vaping intention, there is a paucity of scholarship that differentiates the sources where adolescents obtain e-cigarette information in their investigation, which limits our understanding of the unique association between vaping intention and e-cigarette information acquisition from specific sources. In addition, few studies have systematically examined the mechanism of the aforementioned associations. To fill the gap, an online national survey on a panel of adolescents between 13 to 17 years old was conducted. After controlling for potential confounders, several significant indirect effects were observed. Specifically, adolescents' vaping intention was negatively associated with e-cigarette information seeking from health professionals but positively with e-cigarette information exposure from family and friends, outdoors advertisements, social media, and other online channels, with the theory of planned behavior (TPB) constructs mediating these relationships. The findings not only contribute to the body of scholarship on TPB but also provide important suggestions for regulating outdoor and online e-cigarette information and designing persuasive interventions and campaigns.

Communicative Processes Underlying DIY eJuice Mixing Among Young Adult International ENDS Users

The use of electronic nicotine delivery systems (ENDS) is increasing around the world, with contemporary trends outpacing scientific understanding of the health implications. Such trends include do-it-yourself eJuice mixing (DIY eJuice), which involves the unregulated homemade mixing of fogging agents, nicotine salts, and flavorants to create personalized liquid for ENDS products. The purpose of this study was to employ a grounded theory approach to gather formative data on the communicative processes surrounding the behavior of DIY eJuice mixing among international, young adult ENDS users. Participants were recruited locally for mini focus group discussions via SONA (n = 4) and internationally for an open-ended survey via Prolific (n = 138). Questions explored experiences with the online DIY eJuice community, motivations for mixing, information seeking strategies, flavor preferences, and perceived benefits of mixing. Thematic analysis and flow sketching revealed the underlying processes of social cognitive theory to explain the communicative processes of DIY eJuice mixing behaviors. Specifically, environmental determinants emerged in the form of online and social influences; personal determinants in the form of curiosity and control; and behavioral determinants following a benefits/barriers analysis, particularly regarding cost. These findings provide theoretical implications for the role of health communication constructs in understanding contemporary trends in ENDS use and practical implications for tobacco prevention messaging and tobacco control regulations.

How does health communication on social media influence e-cigarette perception and use? A trend analysis from 2017 to 2020

OBJECTIVE

E-cigarettes have achieved a high prevalence rapidly. While social media is among the most influential platforms for health communication, its impact on attitudes and behaviors of e-cigarettes and its changes over time remain underexplored. This study aims to address the gap.

METHODS

Four years of data (2017-2020) were derived from the U.S. Health Information National Trends Survey (HINTS) (aged 18-64 years, n = 9,914). Initially, key variables were compared across years. Furthermore, guided by the health belief model, we employed a moderated mediation model to examine the influence of social media health communication on the public's perceptions and behaviors related to e-cigarettes, distinguishing between smokers and non-smokers throughout the four-year period.

RESULTS

The evidence shows a process of dynamic interaction between communication, perception, and behavior. (1) We observed an increasing trend of social media health communication (SMH) and perceived relative harm of e-cigarettes (PHE). (2) Higher SMH was associated with more e-cigarette use directly in 2019. (3) Higher SMH was associated with less e-cigarette use indirectly through PHE in 2020. (4) Smokers consistently displayed heightened sensitivity in responding to harm perception compared to non-smokers.

CONCLUSIONS

The findings support two mechanisms underlying the association between SMH and e-cigarette use: direct and indirect. The changes in the pathways during the timespan may have been influenced by increased e-cigarette information on social media and public health events like COVID-19. Stricter regulations for unverified e-cigarette advertisements and anti-e-cigarette education on social media are called for to curtail e-cigarette use.

Effectiveness of social video platforms in promoting smoking cessation among youth: A content-specific analysis of smoking cessation topic videos on the social platform Bilibili

INTRODUCTION

Smoking cessation is a significant public health issue for young people. Social media provide the public with health knowledge through various types of videos. Bilibili is a trendy social video platform among the young population in China, and the number of smoking cessation videos on this platform is continuously increasing. Different content creators advocating smoking cessation through videos may influence young people's attitudes and behaviors towards tobacco and smoking. This study aims to measure the message sensation value (MSV) and the information appeals in smoking cessation videos on Bilibili, examining their impact on communication effectiveness.

METHODS

This study collected 337 videos from Bilibili and conducted a content analysis regarding the content creator's information, video presentation, MSV, and message appeals. The communication effectiveness of the videos was defined as a dependent variable and was divided into three dimensions: communication breadth, recognition, and participation.

RESULTS

The average MSV (rated on a scale of 0 to 11) for smoking cessation-themed videos was 4.49 (SD=2.23). Chi-squared analysis revealed significant differences among different types of videos in the use of threat appeal (p<0.001), humor appeal (p<0.001), and psychological benefit (p<0.05). Additionally, different types of creators showed differences in the use of threat appeal (p<0.05), humor appeal (p<0.001), and psychological benefit (p<0.05). ANOVA results indicated significant differences in the level of MSV among different smoking cessation videos (F=39.775, p<0.001). Linear regression analysis showed that MSV, threat appeal, humor appeal, and economic benefit positively impacted dissemination effects (p<0.001).

CONCLUSIONS

The results indicate that young people are likelier to watch smoking cessation videos with higher MSV and information appeal. These elements can enhance persuasion and the effectiveness of communication. Therefore, when video creators aim to promote smoking cessation among young people, they can consider factors such as MSV, threat appeal, humor appeal, and economic benefit to enhance communication effects.

A comprehensive content analysis of 104 Chinese electronic cigarette manufacturing enterprise official websites

OBJECTIVE

The goal was to analyse website content of Chinese electronic (e) cigarette manufacturing enterprises and understand the marketing strategies to provide evidence for decision-makers to regulate manufacturers.

METHODS

Through QCC.com, one of the largest enterprise information query platforms in China, we identified 104 official manufacturer websites in 2021. A codebook including 6 sections with 31 items was developed and all webpages were coded separately by two trained researchers.

RESULTS

Over half of the websites (56.7%) did not have age verification for entry. Thirty-two (30.8%) websites had no restriction for minors to use or purchase e-cigarettes, and 79 (76.0%) had no health warning. Overall, 99 websites (95.2%) displayed their products, and 72 (69.2%) displayed e-flavours. The most frequently used descriptions of products included good taste (68.3%), positive mood (62.5%), leakage resistance (56.7%), enjoyment (47.1%), reduced harm (45.2%), alternatives to cigarettes (43.3%) and long battery life (42.3%). Additionally, 75 websites (72.1%) provided contact information on different channels, including WeChat (59.6%), Weibo (41.3%), Facebook (13.5%), Instagram (12.5%) and brand apps (2.9%). Manufacturers provided investment and franchise information (59.6%) and offline store information (17.3%). In addition, 41.3% websites included content regarding corporate social responsibility.

CONCLUSIONS

Chinese e-cigarette manufacturers' official websites have become a platform for presenting product and brand information, establishing online and offline marketing loops, and displaying corporate social responsibility with weak age restrictions on access and a lack of health warnings. The Chinese government should implement strict regulatory measures on e-cigarette enterprises.

Influence of User Profile Attributes on e-Cigarette-Related Searches on YouTube: Machine Learning Clustering and Classification

Background

The proliferation of e-cigarette content on YouTube is concerning because of its possible effect on youth use behaviors. YouTube has a personalized search and recommendation algorithm that derives attributes from a user's profile, such as age and sex. However, little is known about whether e-cigarette content is shown differently based on user characteristics.

Objective

The aim of this study was to understand the influence of age and sex attributes of user profiles on e-cigarette-related YouTube search results.

Methods

We created 16 fictitious YouTube profiles with ages of 16 and 24 years, sex (female and male), and ethnicity/race to search for 18 e-cigarette-related search terms. We used unsupervised (k-means clustering and classification) and supervised (graph convolutional network) machine learning and network analysis to characterize the variation in the search results of each profile. We further examined whether user attributes may play a role in e-cigarette-related content exposure by using networks and degree centrality.

Results

We analyzed 4201 nonduplicate videos. Our k-means clustering suggested that the videos could be clustered into 3 categories. The graph convolutional network achieved high accuracy (0.72). Videos were classified based on content into 4 categories: product review (49.3%), health information (15.1%), instruction (26.9%), and other (8.5%). Underage users were exposed mostly to instructional videos (37.5%), with some indication that more female 16-year-old profiles were exposed to this content, while young adult age groups (24 years) were exposed mostly to product review videos (39.2%).

Conclusions

Our results indicate that demographic attributes factor into YouTube's algorithmic systems in the context of e-cigarette-related queries on YouTube. Specifically, differences in the age and sex attributes of user profiles do result in variance in both the videos presented in YouTube search results as well as in the types of these videos. We find that underage profiles were exposed to e-cigarette content despite YouTube's age-restriction policy that ostensibly prohibits certain e-cigarette content. Greater enforcement of policies to restrict youth access to e-cigarette content is needed.

User-generated content and influencer marketing involving e-cigarettes on social media: a scoping review and content analysis of YouTube and Instagram

BACKGROUND

Evidence suggests that experimentation with e-cigarettes among young people is increasing. Social media is widely used by young people with user-generated content and influencer marketing particularly influential in promoting products. This paper documents a snapshot of online user-generated content and influencer marketing related to e-cigarettes on YouTube and Instagram.

METHODS

Scoping review of relevant e-cigarette-related content on two social media platforms popular with youths, YouTube and Instagram, between June and August 2021. Content analysis was undertaken to examine text, audio, and video content, recording age restrictions, health warnings, page characteristics, and post characteristics. Narrative post content was coded using a coding frame that was developed inductively in response to emergent categories.

RESULTS

Vaping was portrayed positively on social media; of the posts analysed, 86.5% (n = 90 of 104) of Instagram posts and 66.0% (n = 64 of 97) of YouTube videos. Warnings about age restrictions and health (e.g., nicotine addiction/toxicity) did not feature in the majority of posts; 43.3% (n = 42) of YouTube videos (n = 42) contained an age warning compared to 20.2% of Instagram posts (n = 21). While 25.8% (n = 25) of YouTube videos and 21.2% of Instagram (n = 22) posts contained a health warning.

CONCLUSION

Of concern is the fact that the vast majority of YouTube and Instagram content about e-cigarettes promoted their use, and typically the content does not contain age and/or health warnings. These findings may highlight a priority for governmental policy to restrict the ability of marketers to reach youths with social media content promoting e-cigarettes.

A Comparative Analysis of E-Cigarette and Cigarette Posts on Instagram

E-cigarette use has grown rapidly over the past decade and become a threat to public health. Marketing-especially through social media-has contributed significantly to this growth, which suggests that regulating content in social media will be critical in supporting efforts to reverse this trend. A content analysis was performed to compare 254 e-cigarette posts on Instagram with 228 cigarette posts on the same platform. The majority of e-cigarette posts were from e-cigarette companies (40.9%) and industry people (18.5%), whereas the majority of cigarette posts were from laypeople (76.8%). More e-cigarette posts than cigarette posts appeared to have a marketing intent (56.3% vs. 1.3%), and brand representation in photographs/videos was more frequent in the e-cigarette posts than in the cigarette posts (63.0% vs. 15.8%). Further, compared with the e-cigarette posts, the cigarette posts were more likely to portray daily life (73.2% vs. 41.3%) and humans (80.3% vs. 43.7%) in the photograph/video. The cigarette posts also portrayed smoking much more often than the e-cigarette posts portrayed vaping (67.1% vs. 21.3%). The study findings broaden the field's understanding of cigarette and e-cigarette content on Instagram and social media, and have implications for monitoring and regulating content for e-cigarettes and cigarettes.

How Does Social Media Exposure and Engagement Influence College Students' Use of ENDS Products? A Cross-lagged Longitudinal Study

Electronic nicotine delivery systems (ENDS) products have been marketed heavily on social media throughout the past years, which exerts great influence on young adults' ENDS use. Despite scholars' pioneering efforts in investigating the influence of tobacco and nicotine products marketing on young adults' vaping behavior, scholarly attention has been paid primarily to passive exposure to rather than active engagement with the information on social media. In addition, the majority of existing research has been cross-sectional or focused on the unidirectional path from marketing information to behavior. To extend previous research in tobacco regulatory science on new media, we examined the bidirectional associations between self-reported exposure to and engagement with tobacco and nicotine products messaging on social media, and subsequent use of ENDS products one year later among a large, diverse sample of young adults. Results from cross-lagged panel analyses indicated that pro-tobacco/ENDS engagement and advertising exposure elevated risk whereas anti-tobacco/ENDS engagement decreased risk for the subsequent use of ENDS products one year later. On the other hand, the use of ENDS products positively predicted both pro- and anti-tobacco/ENDS engagement one year later. Findings provide empirical support for the reasoned action approach and the confirmation bias rooted in cognitive dissonance theory through rigorous longitudinal examination. Our findings not only point to the imperativeness of and offer guidance for regulating marketing information on social media, but also suggest social media as a promising platform to prevent young adults from initiating ENDS product use.

A Systematic Review of E-Cigarette Marketing Communication: Messages, Communication Channels, and Strategies

Marketing plays a key role in increasing the popularity of e-cigarettes. We conducted a systematic review of the existing literature published between 2003 and 2019 in eight databases to describe e-cigarette marketing communication messages by communication channels and marketing communication strategies. Forty-one articles were included in the analysis after screening. Ten key messages were identified. Cessation and health-related benefits (each n = 31, 75.6%) were the most reported marketing communication messages, followed by sociability/lifestyle and use experience. The Internet (n = 32, 78.0%) was the most studied communication channel compared to print, TV/movie/radio, and point-of-sales (POS)/retail stores. The most studied marketing communication strategies were advertising (n = 28, 68.3%), followed by public relations and sales promotion. Published research studies reported consistent messages about e-cigarettes across communication channels and marketing communication strategies. Claims of smoking cessation and health-related benefits were widely identified in the existing literature. While therapeutic claims are prohibited, soft sell messages, such as social appeals, for which regulatory reach may be limited, may require educational campaigns. Internet marketing has attracted much attention, with limited studies on messages in print, TV/movie/radio, and POS/retail stores. The lack of studies of direct marketing messaging indicates a big gap between industry spending and academic research; more studies of messaging utilizing this strategy are needed.

A Content Analysis of U.S. Adults' Open-Ended Responses to E-Cigarette Risk Messages

To better understand the processing of e-cigarette prevention messages, we conducted a content analysis of 1,968 participants' open-ended responses to one of four messages, which focused on industry manipulation (Big tobacco), financial and psychological cost of vaping (Can't afford), harmful chemicals in e-cigarettes (Formaldehyde), or uncertainty about the ingredients of e-liquids (Top secret). Health Belief Model (HBM) and perceived message effectiveness (PME) constructs were coded and the frequency of each variable was compared across message conditions. Among the HBM constructs, perceived health threat had the most mentions overall (38.8%). Self-efficacy of staying away from vaping had the fewest mentions across all messages (0.56%). For PME, participants more frequently mentioned message perceptions (15.75% positive message perceptions, 8.38% negative) than effect perceptions (3.46% positive effect perceptions, 1.37% negative). Big tobacco received the highest number of mentions for positive message perceptions and Formaldehyde received the highest number of mentions for positive effect perceptions. Future anti-vaping messages are recommended to address the efficacy element and to combine different themes to communicate harms of e-cigarettes.

#NicotineAddictionCheck: Puff Bar Culture, Addiction Apathy, and Promotion of E-Cigarettes on TikTok

This study aimed to classify and delineate types of user-generated content about the disposable e-cigarette Puff Bar shared on the popular video-based social media platform TikTok. We qualitatively analyzed 148 popular TikTok videos collected in July 2020. During an iterative process of data reduction and thematic analysis, we categorized videos by overarching genres and identified emergent themes. Young adults were engaged at all stages of the research process. Together, videos were viewed over 137 million times on TikTok. Seven genres of Puff Bar content emerged: skits and stories, shared vaper experiences, videos to show off, product reviews, product unboxing, promotion of Puff Bar, and crafts. Videos depicted Puff Bar users’ apathy about addiction and a lack of concern of the health effects of e-cigarette use. Additionally, Puff Bar promotion content from underground retailers was extensive and some targeted underage persons. Qualitative analysis of social media content can richly describe emerging online culture and illuminate the motivations of adolescent and young adult e-cigarette use. Social media can facilitate new product adoption; comprehensive e-cigarette regulation and enforcement can counteract these effects by closing loopholes through which new products emerge.

An Investigation of Influential Users in the Promotion and Marketing of Heated Tobacco Products on Instagram: A Social Network Analysis

While an increasing body of the literature has documented the exposure to emerging tobacco products including heated tobacco products (HTPs) on social media, few studies have investigated the various stakeholders involved in the generation of promotional tobacco content. This study constructed a social network of Instagram users who posted IQOS content, a leading HTP brand, between 1 January and 5 April 2021 and identified users who positioned near the center of the network. We identified 4526 unique Instagram users who had created 19,951 IQOS-related posts during the study period. Nearly half of the users (42.1%) were business accounts authorized by Instagram, among which 59.0% belonged to Personal Goods and General Merchandise Stores and 18.1% belonged to Creators and Celebrities. For users with higher in-degree, out-degree, betweenness, and closeness centrality in the network, the majority of them were accounts directly associated with IQOS (e.g., containing "iqos" in username) or related to tobacco business as self-identified in the bio. Our findings further refine the social media marketing presence of tobacco products and suggest that the current self-regulatory efforts led by social media platforms are far from enough.

An Exploration of e-Cigarette-Related Search Items on YouTube: Network Analysis

Background

e-Cigarette use among youth is high, which may be due in part to pro–e-cigarette content on social media such as YouTube. YouTube is also a valuable resource for learning about e-cigarette use, trends, marketing, and e-cigarette user perceptions. However, there is a lack of understanding on how similar e-cigarette–related search items result in similar or relatively mutually exclusive search results. This study uses novel methods to evaluate the relationship between e-cigarette–related search items and results.

Objective

The aim of this study is to apply network modeling and rule-based classification to characterize the relationships between e-cigarette–related search items on YouTube and gauge the level of importance of each search item as part of an e-cigarette information network on YouTube.

Methods

We used 16 fictitious YouTube profiles to retrieve 4201 distinct videos from 18 keywords related to e-cigarettes. We used network modeling to represent the relationships between the search items. Moreover, we developed a rule-based classification approach to classify videos. We used betweenness centrality (BC) and correlations between nodes (ie, search items) to help us gain knowledge of the underlying structure of the information network.

Results

By modeling search items and videos as a network, we observed that broad search items such as e-cig had the most connections to other search items, and specific search items such as cigalike had the least connections. Search items with similar words (eg, vape and vaping) and search items with similar meaning (eg, e-liquid and e-juice) yielded a high degree of connectedness. We also found that each node had 18 (SD 34.8) connections (common videos) on average. BC indicated that general search items such as electronic cigarette and vaping had high importance in the network (BC=0.00836). Our rule-based classification sorted videos into four categories: e-cigarette devices (34%-57%), cannabis vaping (16%-28%), e-liquid (14%-37%), and other (8%-22%).

Conclusions

Our findings indicate that search items on YouTube have unique relationships that vary in strength and importance. Our methods can not only be used to successfully identify the important, overlapping, and unique e-cigarette–related search items but also help determine which search items are more likely to act as a gateway to e-cigarette–related content.

Association between perceived health risks of e-cigarettes and actual e-cigarette use, based on cigarette smoking status and sexual and gender minority status among U.S. adults

BACKGROUND

There is a lack of consensus in the literature about the association between the perceived health risks of e-cigarettes and their actual use, an association that may be based on cigarette smoking status or sexual and gender minority status. This study examined the moderating effect of these variables as well as differences in e-cigarette use between and within perceived harmfulness of e-cigarettes and cigarette smoking among U.S. adults.

METHODS

The data were drawn from the 2020 and 2019 Health Information National Trends Survey (HINTS 5), Cycles 4 and 3, on adults (N = 9303). We estimated weighted multivariable logistic regression models and conducted marginal analyses based on perceived harmfulness of e-cigarettes.

RESULTS

Of the study population, 30.75% currently used e-cigarettes daily or some days. No significant difference in e-cigarette use was found between sexual minorities and heterosexuals, but there was a significant interaction between sexual identity and perceived harmfulness of e-cigarettes. Compared to non-smokers, current daily or some days cigarette smokers were more likely to use e-cigarettes (AOR = 3.48, 95% CI = 1.25, 9.72). Those who perceived e-cigarettes to be just as harmful as actual cigarettes (AOR = 0.13, 95% CI = 0.06, 0.27) or more harmful (AOR = 0.03, 95% CI = 0.01, 0.10), or were uncertain (AOR = 0.18, 95% CI = 0.08, 0.45), were less likely to use e-cigarettes compared to those who perceived e-cigarettes to be less harmful. Former and current cigarette smokers who perceived e-cigarettes as less harmful had a higher probability of using e-cigarettes daily or some days than did non-cigarette smokers. For the current and former cigarette smoking groups, those who perceived e-cigarettes as less harmful had the highest probability of current e-cigarette use than did those who were uncertain or perceived e-cigarettes as just as harmful, whereas the probability was not significant for those who perceived e-cigarettes as more harmful.

CONCLUSION

Current daily or some days use of e-cigarettes is associated with current daily or some days cigarette smoking and lowered perceived harmfulness of e-cigarettes among the U.S. adult population. Tailored health promotion and intervention efforts may reduce the potential perceived health and behavioral/lifestyle risks related to the use of tobacco products, especially the use of e-cigarettes daily among former and current cigarette smokers as well as those who perceive e-cigarettes as less harmful.

Social Media Discussions on the FDA's Modified Risk Tobacco Product Authorization of IQOS

Background: The U.S. Food and Drug Administration (FDA) authorized the marketing of the IQOS tobacco heating system as a modified risk tobacco product (MRTP) in July 2020, permitting its 'reduced exposure' marketing. This decision is accompanied by much controversy among the global health community. We provide a preliminary analysis of Twitter conversations regarding the MRTP authorization of IQOS by identifying the authors, valence towards the policy decision, source of cited link, and focused topic. Methods: We analyzed 548 tweets mentioning MRTP posted between July 2016 (when PMI submitted the proposal) and October 2020. Results: We found a higher proportion of pro-MRTP valence (25.4%) than anti-MRTP (16.2%). Nearly half of the tweets (47.2%) expressing personal opinions presented pro-MRTP valence (vs. anti-MRTP = 23.9%). The FDA website was more frequently cited in pro-MRTP tweets (30.8% vs. anti = 4.8%), while tobacco control advocates' websites were cited only in anti-MRTP tweets (77.4% vs. pro = 0). Pro-MRTP valence appeared more frequently in tweets mentioning health (53.1% vs. anti =38.5%) and cessation (100% vs. anti = 0). Nearly 42% of tweets showed a bot score greater than .43, indicating a possibility of automation. Conclusion: Continuous efforts are needed to surveil the industry's attempts to create a climate of false consensus and circulate misinformation regarding MRTP on social media, as well as to assist non-scientific audiences' understanding of MRTP.

Nonsmokers' Responses to Online E-Cigarette Commercials: Effects of Argument Quantity and Celebrity Endorsement Paper Resubmitted to Substance Use and Misuse

Objectives: With mounting evidence on health risks caused by e-cigarette consumption, it is of great necessity to explore not only smokers' but also nonsmokers' responses to e-cigarette marketing messages, such as online commercials. Employing both psychophysiological and self-report measures, this study examined nonsmoking young adults' cognitive, emotional, and attitudinal reactions to two major message features used in e-cigarette commercials: argument quantity and endorsement type. Method: The experiment used a 2 (endorsement type: celebrity and average citizen) × 2 (argument quantity: low and high) × 2 (message repetition) within-subjects design. Continuous heart rate (indicative of attention) and skin conductance activity (indicative of emotional arousal) were measured during ads viewing. Self-reported ad liking and vaping urge were assessed immediately after participants finished watching each commercial. Results: Results showed that compared to high argument quantity, low argument quantity elicited more attention, evoked higher emotional arousal, and generated stronger ad liking and vaping urge. Additionally, compared to average-citizen endorsement, the presence of celebrity endorsement elicited higher attention and lower emotional arousal in nonsmoking young adults. There was a significant interaction effect of endorsement type and argument quantity on ad liking. Conclusions: For nonsmoking young adults, low argument quantity commercials might have the greatest impact in initiating vaping behavior, which has implications for regulatory policies regarding e-cigarette. Celebrity endorsement was effective in catching nonsmokers' attention but had limited effects on emotional involvement and product adoption. The implications of the findings were finally discussed in more details in the manuscript.

E-cigarettes use among university students in Jordan: Perception and related knowledge

The use of e-cigarettes has been increasing in popularity among people, especially young adults. Assessing young individuals’ perceptions of e-cigarettes can help to identify factors that may influence their decision to use e-cigarettes. To examine prevalence, perceptions, and knowledge of e-cigarettes among university students in Jordan, an observational cross-sectional study using an online self-administered questionnaire was conducted among students from public and private universities between October 2020 and January 2021. A total of 1259 university students completed the questionnaire. Approximately, 11% of participants reported e-cigarettes use. Among users, 26.5% used it for the purpose of smoking cessation, while 22% of them used it out of curiosity, and 20.5% used it as they believed it is less harmful than other tobacco products. Multivariate analysis showed that conventional cigarette smokers were independently associated with a better knowledge about e-cigarettes (OR = 1.496, 95CI% = 1.018–2.197, p-value = 0.040). In addition, medical students showed a significantly better knowledge compared to non-medical students (OR = 1.710, 95CI% = 1.326–2.204, p-value = <0.001). In Jordan, e-cigarettes use is less popular compared to other countries. Nonetheless, educational interventions are needed to correct misconceptions about e-cigarettes among young adults.

Co-occurring substance use and psychological distress among exclusive e-cigarette use and other tobacco use among sexual and gender minorities in Texas

BACKGROUND

There is a dearth of literature on sexual and gender minority (SGM) only data that examines the association between tobacco use, co-occurring substance use, and psychological distress.

METHODS

Using SGM-only primary data collected between March 2016 and January 2017, participants were categorized based on recent tobacco use and prevalence estimates were calculated for exclusive e-cigarette use and use of other tobacco products. The strength of the association between tobacco use, recent hazardous alcohol use, illicit substance use, and having a diagnosis for depression, anxiety, or PTSD was estimated. Bivariate and adjusted multinomial logistic regression analyses were used to obtain estimates.

RESULTS

A third of participants (32.91%) reported recent tobacco use. Of these, 8.79% were exclusive e-cigarette users and 24.12% used other tobacco products. Compared to non-tobacco users, e-cigarette users were more likely to have recently used illicit drugs (RRR= 3.00 [1.89, 4.77]) and participated in a substance use treatment program (RRR= 7.98 [1.76, 36.15]). Participants categorized as using other tobacco products, when compared to non-tobacco users, were more likely to have recently used illicit drugs (RRR= 2.05 [1.46, 2.86]), engaged in hazardous drinking (RRR= 2.27 [1.63, 3.16]), and participated in a substance use treatment program (RRR= 9.53 [3.14, 28,88]). They were also more likely to have been recently diagnosed with PTSD (RRR= 3.40 [1.82, 6.34]).

CONCLUSIONS

SGM tobacco users are more likely to engage in hazardous drinking and illicit substance use and access substance use treatment services. There is an opportunity to reduce tobacco use among SGM individuals by developing, implementing, and evaluating tailored tobacco cessation interventions within substance use treatment facilities.

Videos With the Hashtag #vaping on TikTok and Implications for Informed Decision-making by Adolescents: Descriptive Study

BACKGROUND

Despite the public health importance of vaping and the widespread use of TikTok by adolescents and young adults, research is lacking on the nature and scope of vaping content on this networking service.

OBJECTIVE

The purpose of this study is to describe the content of TikTok videos related to vaping.

METHODS

By searching the hashtag #vaping in the discover feature, ~478.4 million views were seen during the time of data collection. The first 100 relevant videos under that hashtag were used in this study. Relevance was determined by simply noting if the video was related in any way to vaping. Coding consisted of several categories directly related to vaping and additional categories, including the number of likes, comments, and views, and if the video involved music, humor, or dance.

RESULTS

The 100 videos included in the sample garnered 156,331,347 views; 20,335,800 likes; and 296,460 comments. The majority of the videos (n=59) used music and over one-third (n=37) used humor. The only content category observed in the majority of the videos sampled was the promotion of vaping, which was included in 57 videos that garnered over 74 million views (47.5% of cumulative views). A total of 42% (n=42) of the 100 videos sampled featured someone vaping or in the presence of vape pens, and these videos garnered over 22% (>35 million) of the total views.

CONCLUSIONS

It is necessary for public health agencies to improve understanding of the nature and content of videos that attract viewers' attention and harness the strength of this communication channel to promote informed decision-making about vaping.

Characterization of Electronic Cigarette Warning Statements Portrayed in YouTube Videos

INTRODUCTION

In 2018, the United States Food and Drug Administration (FDA) required that electronic cigarette (e-cigarette) manufacturers, packagers, importers, distributors, and retailers display an addictive or alternate warning statement on e-cigarette visual advertisements. Few studies have investigated the FDA-mandated and other warnings on social media. This study examined the prevalence and content of warning statements in e-cigarette-related YouTube videos.

METHODS

In 2019, The Virginia Commonwealth University Center for the Study of Tobacco Products conducted bi-monthly (February-June) YouTube searches by relevance and view count to identify e-cigarette-related videos. Overall, 178 videos met the inclusion criteria. Staff coded each video for the presence of a visual/verbal warning statement, warning statement type (eg, FDA-mandated, addiction/tobacco, safety/toxic exposure, health effects), sponsorship, and tobacco product characteristics. A data extraction tool collected the video URL, title, upload date, and number of views, likes/dislikes, and comments.

RESULTS

Only 5.1% of videos contained FDA-mandated and 21.9% contained non-mandated warnings. All videos with FDA-mandated and 46.2% of non-mandated warnings were represented visually. Only 13.1% of industry-sponsored videos uploaded after the mandate effective date had an FDA-mandated warning statement and videos with FDA-mandated and non-mandated (v. no) warnings had significantly fewer views, likes, dislikes, and comments. Among all non-mandated warnings, 31.3% featured an addiction/tobacco, 18.8% a safety/toxic exposure, and 37.5% a health effects warning.

CONCLUSIONS

The prevalence of FDA-mandated warning statements in e-cigarette related YouTube videos was low. FDA enforcement of the warning statement mandate on YouTube could increase the public's understanding of the addictive nature of nicotine in e-cigarettes.

IMPLICATIONS

The FDA has the authority to regulate the advertisement and promotion of e-cigarettes on the Internet. These data can inform future FDA requirements related to the language content and visual representation of addiction/tobacco, safety/exposure, and health effects warning statements that appear in YouTube videos and other visual social media popular among young people. Such data would help consumers make informed decisions about purchasing e-cigarette products, using e-cigarettes, and avoiding unintentional harm related to e-cigarettes. In addition, these data may help social media platforms make decisions on whether they will prohibit advertisements that promote or facilitate the sale of tobacco products.

Exploratory Analysis of Electronic Cigarette-Related Videos on YouTube: Observational Study

BACKGROUND

Electronic cigarette (e-cigarette) use has become more popular than cigarette smoking, especially among youth. Social media platforms, including YouTube, are a popular means of sharing information about e-cigarette use (vaping).

OBJECTIVE

This study aimed to characterize the content and user engagement of e-cigarette-related YouTube videos.

METHODS

The top 400 YouTube search videos related to e-cigarettes were collected in January 2020. Among them, 340 valid videos were classified into provaping, vaping-warning, and neutral categories by hand coding. Additionally, the content of e-cigarette videos and their user engagement (including average views and likes) were analyzed and compared.

RESULTS

While provaping videos were dominant among e-cigarette-related YouTube videos from 2007 to 2017, vaping-warning videos started to emerge in 2013 and became dominant between 2018 and 2019. Compared to vaping-warning videos, provaping videos had higher average daily views (1077 vs 822) but lower average daily likes (12 vs 15). Among 161 provaping videos, videos on user demonstration (n=100, 62.11%) were dominant, and videos on comparison with smoking had the highest user engagement (2522 average daily views and 28 average daily likes). Conversely, among 141 vaping-warning videos, videos on potential health risks were the most popular topic (n=57, 40.42%) with the highest user engagement (1609 average daily views and 33 average daily likes).

CONCLUSIONS

YouTube was dominated by provaping videos, with the majority of videos on user demonstrations before 2018. The vaping-warning videos became dominant between 2018 and 2019, with videos on potential health risks being the most popular topic. This study provides updated surveillance on e-cigarette-related YouTube videos and some important guidance on associated social media regulations.

Rating the Valence of Media Content about Electronic Cigarettes Using Crowdsourcing: Testing Rater Instructions and Estimating the Optimal Number of Raters

Electronic cigarettes (e-cigarettes) are a controversial public health topic due to their increasing popularity among youth and the uncertainty about their risks and benefits. Researchers have started to assess the valence of media content about e-cigarette use, mostly using expert coding. The current study aims to offer a methodological framework and guideline when using crowdsourcing to rate the valence of e-cigarette media content. Specifically, we present (1) an experiment to determine rating instructions that would result in reliable valence ratings and (2) an analysis to identify the optimal number of raters needed to replicate these ratings. Specifically, we compared ratings produced by crowdsourced raters instructed to rate from several different perspectives (e.g., objective vs. subjective) and determined the instructions that led to reliable ratings. We then used bootstrapping methods and a set of criteria to identify the minimum number of raters needed to replicate these ratings. Results suggested that when rating e-cigarette valence, instructing raters to rate from their own subjective perspective produced reliable results, and nine raters were deemed the optimal number of raters. We expect these findings to inform future content analyses of e-cigarette valence. The study procedures can be applied to crowdsourced content analyses of other health-related media content to determine appropriate rating instructions and the number of raters.

Influence of online comments on smokers' E-cigarette attitude: Opinion climate, review fraud, and resistance to persuasion

OBJECTIVE

This study examined the effect of online comments on smokers' attitude toward trying e-cigarettes. It also explored the effect of an unobtrusive forewarning in increasing smokers' resistance to online review fraud.

DESIGN

739 adult smokers participated in an experiment with a 2 comment valence (supportive vs. oppositional) x 3 comment deception warning (no warning vs. early warning vs. late warning) + 1 control (no comment) factorial design. Smokers watched two e-cigarette commercials. The control group received only the ads. The treatment groups saw 10 to 12 comments following each ad.Main Outcome Measure: E-cigarette attitude.

RESULTS

Smokers who read supportive (M = 5.28, SD = 1.37), oppositional (M = 4.96, SD = 1.53), and no comment (M = 5.44, SD = 1.20) showed significant difference on their e-cigarettes attitude, p = .004. When the comment climate was overly in favor of e-cigarettes, warning smokers of review fraud could raise their awareness of comment deception, increase defensive processing, decrease their social identification with commenters, and eventually lower their interest in trying e-cigarettes.

CONCLUSION

The overall opinion climate in the form of aggregated valence of comments could sway smokers' e-cigarette attitude. Smokers could benefit from warnings of online review fraud.

An update on controversies in e-cigarettes

E-cigarettes are electronic nicotine delivery systems (ENDS) which mimic tobacco smoking without the combustion of tobacco. These devices have been misleadingly marketed as "less harmful" alternatives to conventional smoking tobacco products. The e-liquid in e-cigarettes include nicotine, a humectant and other additives including flavourings, colourants, or adulterants such as bacterial and fungal products. In this review, we discuss the contrasting views of the tobacco lobby and most professional societies. We describe the epidemiology of the use of these devices, with a widespread and significant rise in youth e-cigarette use seen in both the USA and Europe. We also describe what is known about the toxicity and mechanisms of EVALI (e-cigarette or vaping associated lung injury). This characterised by respiratory failure with an intense inflammatory response. The presentations are diverse and clinicians should consider vaping as a possible cause of any unusual respiratory illness in patients who have a history of vaping or other use of e-cigarette-related products. Second hand exposure to e-cigarettes is also harmful through respiration and transdermal absorption. E-cigarettes have a worse acute toxicity than tobacco and their long-term toxicity is unknown, and we advocate for the immediate, most vigorous anti-vaping legislation possible.

An experimental study of messages communicating potential harms of electronic cigarettes

There has been an upsurge of e-cigarette use in the United States in recent years. While e-cigarettes may contain lower levels of toxic chemicals than combusted cigarettes, they still pose serious health hazards, including increased risk for heart and respiratory disease. Despite these risks, public awareness of the health harms of e-cigarettes remains low. Thus, it is important to educate the public about the potential harms of e-cigarettes. This study took themes commonly found in antismoking messages and used them to develop messages about harms of e-cigarettes. A national sample of 2801 current smokers and nonsmokers (aged 18+ years) were randomized to view one of four e-cigarette messages (harmful effect of chemicals, uncertainty about ingredients, distrust of big tobacco, or cost of vaping) or a control message (bottled water ad). Participants' reactions to the messages and behavioral intentions were assessed immediately following the exposure. MANOVA examined effects of the messages on blocks of the outcome variables and univariate analyses estimated adjusted means for each experimental condition for each outcome. The message about harmful chemicals was perceived as the most informative and effective and elicited the highest levels of negative emotions (Ps<0.05). However, on measures of actual effectiveness, the other messages performed equally well. Specifically, messages with different themes (harmful chemicals, uncertainty about ingredients, anti-industry, or financial cost) increased perceived risk of e-cigarettes, support for e-cigarette control, and lowered self-exempting beliefs and intentions to use e-cigarettes (Ps<0.05). Themes commonly used in anti-smoking messages may be effective in educating the public about the potential harm of e-cigarettes. The observed differential effects of the messages suggest the need to use multiple themes in a public education campaign about e-cigarettes.

Objective Facts or Misleading Hype? Associations between Features of E-Cigarette Marketing and Sales on a Chinese E-Commerce Platform

Background: Electronic cigarettes (e-cigarettes) have been increasingly advertised and marketed in China in recent years. This study examined the practice and impact of e-cigarette online marketing on a major retail website—Tmall.com. Methods: Data were obtained by crawling 449 online pages of e-cigarette marketing. Content analysis was conducted to summarize the marketing practices for four types of e-cigarettes, and multilevel modeling (MLM) was implemented to explore factors predictive of the online sales of the products. Results: The sales volume of e-cigarettes ranged from 0 to 28,169, with the price per item varying from RMB 218.1 ($31.84) to RMB 385.5 ($56.29). Fruit (44.3%, n = 199), mint (33%, n = 148) and cream/sugar/ice (29.4%, n = 132) were the three flavors most often listed for sale online. Moreover, 63.4% (n = 285) of e-cigarette ads emphasized the role of the products as an aid to quit smoking. Nice taste (75.1%), big vapor (65.7%), high capacity batteries (67.9%), fashionable models (61.3%), discounted price (49.7%), and suitability for gifting (45.9%) were the most frequently touted product features in online ads. Type of e-cigarettes, diversity of products, number of online comments, and location of manufacturers were significantly associated with sales volume. Conclusions: Online marketing of e-cigarettes was common on one of China’s leading e-commerce websites. Sellers employed advertising strategies targeting a wide range of potential consumers—from youth to the elderly. Stricter regulations of online marketing for e-cigarettes should be enforced in China.

The role played by health resistance, coping response, and smoke damage perceptions in smoking threat appeal campaigns

Threat appeal campaigns have been widely used to induce people to change their bad smoking habits by adopting a better approach in favor of a healthier lifestyle. Social marketers who create this kind of messages tend to believe in the persuasive power of fear arousal. For most people, fear has an important consequence on behavior, leading them to search for means of deleting or coping with the unhealthy behavior. As demonstrated by the Ordered Protection Motivation Model, individual differences such as health resistance play an important role in determining, or not, a change of behavior when faced with the threat. This study explores the relationship between health resistance and attitude towards smoking behavior and examines the mediating impact of coping response and smoke damage perception in a sample of 260 university students, smokers and non-smokers. Results highlight that health resistance has an important direct effect on smoking attitude, but, it seems to be mitigated by the smoke severity of the damage shown in graphic images. The comparison between smokers and nonsmokers allowed us to understand the role of reactance in these two groups, and the significance that anti-smoking campaigns assume. Our results offer important suggestions for future decisions about social threat appeals campaigns.

Orthodox and Unorthodox Uses of Electronic Cigarettes: A Surveillance of YouTube Video Content

INTRODUCTION

Open electronic cigarette (e-cigarette) systems are customizable by consumers and often allow for potential "unorthodox" use of the product; that is, use not as intended by the manufacturer. Little is known about the types and prevalence of unorthodox uses and how these practices are transmitted via popular social media.

METHODS

Monthly searches of YouTube were conducted from June through November 2016 using the following search terms: "e-cigarettes," "vaping," and "e-juice." After collecting static and dynamic data on the 150 videos identified, two coders independently coded videos for general information, unorthodox use behaviors, health claims, and production quality and characteristics for orthodox and unorthodox use. Intercoder reliability was high (Cohen's κ 0.81, p < .001).

RESULTS

One hundred fifty videos were included in the study with a total of 115 551 563 views. We identified nine categories of unorthodox uses of e-cigarettes. Unorthodox use was three times as prevalent as orthodox use. Seventy-seven percent of the unorthodox use videos included recreational e-cigarette use, 57% included modification of mechanical parts and components, and 44.6% included unorthodox substance application (dripping). There were more than twice as many social media links in videos depicting unorthodox compared to orthodox use, but the level of engagement was lower for unorthodox use.

CONCLUSIONS

E-cigarette unorthodox use on YouTube is more prevalent than orthodox use, suggesting the need to further investigate the prevalence of unorthodox use among e-cigarette users and the influence of social media on consumer uptake of unorthodox and orthodox uses of e-cigarettes.

IMPLICATIONS

The US Food and Drug Administration has regulatory authority over e-cigarettes, parts and components. Many e-cigarettes currently marketed are open systems. Closed systems may allow less manipulation and may influence the safety of these products. This study provides valuable information on ways that open system e-cigarettes are used and it can inform safety tests that can be conducted by the US Food and Drug Administration to determine whether or not these products should remain on the market. In addition, our definitions of unorthodox use can be incorporated into the Population Assessment of Tobacco on Health Study to better understand the prevalence of these behaviors.

Where college students look for vaping information and what information they believe

Objective: This convergent mixed methods study examined how information sources influence college students' beliefs and knowledge about vaping. Participants: College students either completed a survey (n = 522; January-April, 2016) or were interviewed (n = 33; 2015-2016). Methods: College students completed an online survey asking 'where' students had heard about e-cigarette and 'what' they had heard. Responses were quantified and a chi-square analysis was conducted. Additional college student e-cigarette users were interviewed about the credibility of information sources. Thematic analysis was conducted with the coded interviews. Results: There was a significant relationship between information sources for e-cigarettes (social sources, media, advertising, education/research) and the messages they recalled. Friends who vaped and e-cigarette users were the most credible information sources. Confirmation bias and scientific impotence bias characterized assessment of e-cigarette information. Conclusions: Health education specialists working on college campuses should provide accurate information via communication channels most unitized by college students.

30+ years of media analysis of relevance to chronic disease: a scoping review

BACKGROUND

Chronic, non-communicable diseases are a significant public health priority, requiring action at individual, community and population levels, and public and political will for such action. Exposure to media, including news, entertainment, and advertising media, is likely to influence both individual behaviours, and attitudes towards preventive actions at the population level. In recent years there has been a proliferation of research exploring how chronic diseases and their risk factors are portrayed across various forms of media. This scoping review aims to map the literature in this area to identify key themes, gaps, and opportunities for future research in this area.

METHODS

We searched three databases (Medline, PsycINFO and Global Health) in July 2016 and identified 499 original research articles meeting inclusion criteria: original research article, published in English, focusing on media representations of chronic disease (including how issues are framed in media, impact or effect of media representations, and factors that influence media representations). We extracted key data from included articles and examined the health topics, media channels and methods of included studies, and synthesised key themes across studies.

RESULTS

Our findings show that research on media portrayals of chronic disease increased substantially between 1985 and 2016. Smoking and nutrition were the most frequent health topics, and television and print were the most common forms of media examined, although, as expected, research on online and social media channels has increased in recent years. The majority of studies focused on the amount and type of media coverage, including how issues are framed, typically using content analysis approaches. In comparison, there was much less research on the influences on and consequences of media coverage related to chronic disease, suggesting an important direction for future work.

CONCLUSIONS

The results highlight key themes across media research of relevance to chronic disease. More in-depth syntheses of studies within the identified themes will allow us to draw out the key patterns and learnings across the literature.

Is E-cigarette use a gateway to marijuana use? Longitudinal examinations of initiation, reinitiation, and persistence of e-cigarette and marijuana use

BACKGROUND

Concerns have been raised regarding e-cigarette use as a potential stepping-stone to marijuana use. Based on Kandel's gateway hypothesis, this study investigated if e-cigarette use could lead to marijuana use by testing two hypotheses with a longitudinal national U.S. adult sample, including (1) primary hypothesis: e-cigarette use is a gateway to marijuana use; and (2) falsification hypothesis: marijuana use is not a gateway to e-cigarette use.

METHODS

Adults were extracted from the Population Assessment of Tobacco and Health Study Waves 1-3 (2013-2016). For primary hypotheses, based on baseline e-cigarette use statuses, three study groups were defined, and three logistic regressions were conducted to examine associations between baseline e-cigarette use and follow-up marijuana use initiation, reinitiation, and persistence, respectively. Similarly, for falsification hypotheses, three additional study groups were defined, and three logistic regressions were conducted to examine associations between baseline marijuana use and follow-up e-cigarette use behaviors.

RESULTS

Baseline e-cigarette use was associated with marijuana use initiation and reinitiation (ORs = 2.08, 1.37, respectively, both ps < .05) but not persistence at follow-up. Additionally, baseline marijuana use was associated with only e-cigarette use initiation (OR = 2.23, p < .01) but not reinitiation or persistence at follow-up.

CONCLUSIONS

Findings partially support the gateway hypothesis that e-cigarette use could be a steppingstone to marijuana use reinitiation among the U.S. adults. The mechanisms and behavioral characteristics, such as etiological and psychosocial factors, that may pertain to the progression from e-cigarette use to reinitiation of other substance use should be further investigated to inform effective behavioral, educational, and policy interventions.

Breadth of Media Scanning Leads to Vaping among Youth and Young Adults: Evidence of Direct and Indirect Pathways from a National Longitudinal Survey

Electronic cigarette use among youth and young adults has reached an epidemic proportion of growth. This study examined the direct and indirect effects of the breadth of media scanning about e-cigarette use on subsequent vaping behavior through interpersonal communication and changes in descriptive norm perceptions. We conducted a nationally representative longitudinal phone survey of 13- to 25-year-olds from June 2014 to March 2017, with 11,013 respondents who completed a baseline survey, among which 3,212 completed a follow-up 6 months later. The results from both cross-sectional and lagged analyses provided robust evidence to suggest that passive routine exposure to e-cigarette use content from more media outlets predicted increased likelihood of vaping among youth and young adults. High scanners were about twice as likely to vape as non-scanners (17% versus 9%). Mediation models using bootstrapping procedures found that breadth of scanning predicted higher descriptive norm perceptions which were associated with subsequent vaping; in addition, interpersonal communication mediated the relationship between breadth of scanning and changes in descriptive norm perceptions. These findings highlight the important roles of scanning, norm perceptions and interpersonal discussions in shaping cognition and behavior changes. The results also suggest an overall pro-e-cigarette public communication environment, which warrants further examination.

Rural-urban differences e-cigarette ever use, the perception of harm, and e-cigarette information seeking behaviors among U.S. adults in a nationally representative study

Adults living in rural areas, compared to their urban counterparts, are at an increased risk of using tobacco-related products and mortality due to tobacco-related diseases. The harms and benefits of e-cigarette use are mixed, and similarly obscure messaging about these harms and benefits have a critical influence on e-cigarette uptake and perceptions. However, little is known about rural-urban differences in the prevalence of adult e-cigarette daily usage. Using the Health Information National Trends Survey-Food and Drug Administration (HINTS-FDA) cycles 1 and 2, we conducted weighted logistic regressions to assess rural-urban differences in the prevalence of adult e-cigarette daily usage, perceived harm, and e-cigarette information seeking behaviors. This analysis included adults aged 18 years and older in the United States (N = 4229). Both rural and urban respondents reported a similar history of e-cigarette use. Rural respondents were significantly more likely than urban respondents to trust religious organizations and leaders and tobacco companies for information about e-cigarettes. Rural and urban respondents were equally as likely to believe e-cigarettes are addictive, perceive e-cigarette use as harmful, and believe e-cigarettes are more harmful than tobacco cigarettes. Respondents were equally as likely to look for information on e-cigarettes, the health effects of e-cigarettes, and cessation; and, to seek e-cigarette information from healthcare professionals, family and friends, and health organizations and groups. Given our findings, it will be pertinent to continue to research the potential harms of e-cigarette use and develop accurate health communication messages to avoid rural-urban disparities observed for cigarette smoking-related outcomes.

Electronic Cigarette Themes on Twitter: Dissemination Patterns and Relations with Online News and Search Engine Queries in South Korea

This study examines multiple aspects of e-cigarette mentions on different online media channels during the announcement and implementation of a cigarette tax increase policy in South Korea. It consists of three parts. First, a Naive Bayes classifier was used to sort 59,147 tweets about e-cigarettes into five pre-designated themes - promotion, health, policy, product evaluation, and price - and to determine their relative prevalence. Second, social network analysis was used to identify the themes' dissemination patterns. Third, the themes were examined for their associations with e-cigarette mentions in two other media channels - online news articles (n = 580) and search engine queries (64 weeks of Google Trends data). Results show that the most prevalent tweet theme was product evaluation, and the theme with the largest increase during the data collection period was promotion. Promotion-themed tweets were the least connected with tweets about the other five themes, while health-themed tweets were the most connected. Finally, product evaluation-themed tweets exhibited the strongest correlation with search engine query count and had the largest explanatory power.

How Health Communication via Tik Tok Makes a Difference: A Content Analysis of Tik Tok Accounts Run by Chinese Provincial Health Committees

During the last two decades, social media has immersed itself into all facets of our personal and professional lives. The healthcare sector is no exception, with public health departments now capitalizing on the benefits that social media offers when delivering healthcare education and communication with citizens. Provincial Health Committees (PHCs) in China have begun to adopt the micro-video sharing platform, Tik Tok, to engage with local residents and communicate health-related information. This study investigates the status quo of official Tik Tok accounts managed by PHCs in mainland China. In total, 31 PHC accounts were analyzed during August 2019, while the top 100 most liked micro-videos were examined using content analysis. Coding included three major aspects: Quantified Impact, Video Content, and Video Form. 45.2% (n = 14) of PHCs had official Tik Tok accounts. A limited number of accounts (n = 2) were yet to upload a micro-video, while most (n = 9) had uploaded their first micro-video during 2019. For the top 100 most liked micro-videos, a sharp difference was observed in terms of number of Likes, Comments and Reposts. Videos containing cartoons or documentary-style content were most frequently watched by citizens. Similarly, content that promoted professional health or provided knowledge of diseases was frequently viewed. Content containing original music, formal mandarin language, subtitles, and which lasted less than 60 s, were most frequently followed. It is considered a missed opportunity that most PHCs struggle to take advantage of the Tik Tok platform, especially given its growing popularity and daily increase in account creation.

Listening to Adolescents: Their Perceptions and Information Sources About E-cigarettes

PURPOSE

There has been a sharp increase in adolescent electronic cigarette (e-cigarette) use, and e-cigarettes are now the most commonly used tobacco product among U.S. middle and high school students. Frequent use among high school students was reported to be 27.7% in 2018, an increase of almost 8% from 2017. As yet we have only a limited understanding of adolescent perceptions of e-cigarettes and where adolescents receive information about them.

DESIGN AND METHODS

Thirty-four adolescents from Western New York participated in semi-structured interviews. Both adolescents who had used e-cigarettes and never used e-cigarettes were included to capture a broad perspective. The interview data were analyzed using content analysis.

RESULTS

Both adolescents who had used e-cigarettes and never used e-cigarettes acknowledged the popularity and acceptance of e-cigarettes among their peers. E-cigarettes were viewed as a healthy alternative to regular cigarettes that mimicked the appearance but were less harmful and more enjoyable. Reasons for not using e-cigarettes included harms to health, risk of addiction, and the gateway effects for other risky behaviors. Major information sources about e-cigarettes included advertisements, family, peers, social media, and the internet.

CONCLUSIONS

Adolescent perceptions of e-cigarettes, which contribute to reasons for e-cigarette use or not use, and the sources of information that may influence those perceptions were identified.

PRACTICAL IMPLICATIONS

Our findings provide valuable information to guide prevention initiatives and develop interventions, particularly planning for preventive messages and effective communication methods to deliver for adolescents.

Promotion of Vape Tricks on YouTube: Content Analysis

BACKGROUND

The ability to perform vape tricks (ie, blowing large vapor clouds or shapes like rings) using e-cigarettes appeals to youth. Vape tricks are promoted on social media, but the promotion of vape tricks on social media is not well understood.

OBJECTIVE

The aim of this study was to examine how vape tricks were promoted on YouTube to youth.

METHODS

Videos on vape tricks that could be accessed by underage youth were identified. The videos were coded for number of views, likes, dislikes, and content (ie, description of vape tricks, e-cigarette devices used for this purpose, video sponsors [private or industry], brand marketing, and contextual characteristics [eg, model characteristics, music, and profanity]).

RESULTS

An analysis of 59 sample videos on vape tricks identified 25 distinct vape tricks. These videos had more likes than dislikes (11 to 1 ratio) and a 32,017 median view count. 48% (28/59) of the videos were posted by industry accounts (27% [16/59] provaping organizations, 15% [9/59] online shops, and 3% [2/59] vape shops) and 53% by private accounts (55% [17/31] private users, 26% [8/31] vape enthusiasts, and 19% [6/31] YouTube influencers); 53% (31/59) of the videos promoted a brand of e-cigarette devices, e-liquids, or online/vape shops, and 99% of the devices used for vape tricks were advanced generation devices. The models in the videos were 80.2% (160/198) male, 51.5% white (102/198), and 61.6% (122/198) aged 18 to 24 years; 85% (50/59) of the videos had electronic dance music and hip hop, and 32% (19/59) had profanity.

CONCLUSIONS

Vape trick videos on YouTube, about half of which were industry sponsored, were accessible to youth. Restrictions of e-cigarette marketing on social media, such as YouTube, are needed.

Tobacco Risk Information and Comparative Risk Assessment of E-Cigarettes Vs. Cigarettes: Application of the Reinforcing Spirals Model

We examine how individuals seek information about e-cigarette risk and selectively expose themselves to media sources that may provide information consistent with their existing beliefs and behaviors related to e-cigarettes in application of the Reinforcing Spirals Model (Slater, 2007). Additionally, the associations among e-cigarette risk information-seeking, tobacco risk information exposure via media, and comparative risk assessment of e-cigarettes versus conventional cigarettes were identified. The results were compared among current users, former users, and those who had never used e-cigarettes ("never users"). A nationally representative data from the 2017 Health Information National Trends Surveys - FDA was employed. Our analyses suggest the presence of comparative risk perception among current users as assessing the health harm and addiction risk of e-cigarettes significantly lower than cigarettes. Current users did not avoid information about the health effects of e-cigarettes; they were more likely to look for such information than former and never users. Current users' e-cigarette risk information-seeking was negatively associated with the difference between perceived addiction risk of e-cigarettes and that of cigarettes. Current users' tobacco risk information exposure via social media was related with a lower level of the perceived risk of e-cigarettes, while such exposure via news media was related with a higher level of perceived risk of e-cigarettes. Our findings suggest the need for regulating and counteracting the prevalent e-cigarette information that discounts the relative risks of e-cigarettes as well as the potential of news media as influential sources helping current users scrutinize the risks.

Physical activity among adolescent tobacco and electronic cigarette users: Cross-sectional findings from the Population Assessment of Tobacco and Health study

Research examining relationships between protective health behaviors and tobacco use offers valuable insight regarding the behavior profiles of product users. In particular, protective health behavior trends among adolescent e-cigarette users have not been examined thoroughly to date. This study investigates physical activity patterns among adolescent e-cigarette users, smokers, and dual users of both products, as compared with never users of tobacco products.

Data were collected from 8383 youth participants (12–17 years of age) enrolled in Wave 2 (2014–2015) of the nationally-representative Population Assessment of Tobacco and Health Study. Relationships between use of tobacco products and physical activity were examined via weighted multivariable logistic regression procedures. Compared with never users, each product use group demonstrated an increased likelihood to abstain from moderate-vigorous physical activity. While dual users (aOR = 0.52; 95% CI: 0.30–0.85) and smokers (aOR = 0.53; 95% CI: 0.35–0.71) were less likely than never users to participate in vigorous physical activity, no differences were observed between e-cigarette and never users (aOR = 1.04; 95% CI: 0.74–1.47). Dual users consistently demonstrated the lowest likelihood of physical activity participation.

In conclusion, e-cigarette users were more likely to abstain from moderate-vigorous physical activity participation than never users. However, results did not indicate differences in vigorous or muscle-strengthening physical activity participation between e-cigarette users and never users. Though findings specific to moderate-vigorous physical activity demonstrate a behavioral similarity between e-cigarette users and smokers, key differences in vigorous physical activity were observed. Comparatively low physical activity among dual users suggests existence of a behavior profile gradient according to product use.

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Adolescent e-cigarette users were more likely to be physically active than smokers.

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Adolescent nonusers were more likely to be physically active than e-cigarette users.

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A product use-related physical activity behavior profile gradient was observed.

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.

Information Sharing to Promote Risky Health Behavior on Social Media

A large number of posts promoting risky health behavior are posted on social media, but not all posts are widely disseminated. Disseminated information is more likely to influence social media users as users may not be exposed to non-disseminated posts. Thus, this study focuses on principal characteristics of disseminated Twitter posts that attract individuals who promote smoking behavior. After collecting 6,432 tweets and analyzing highly disseminated and non-disseminated Tweets, this study found that Tweets expressing emotional support were observed more than expected among the pro-smoking group and less than expected among the anti-smoking group. Affective tone was also found to be an important factor in Tweet dissemination both in pro- and anti-smoking groups. Interestingly, in the pro-smoking group, Tweets having a negative tone were disseminated more than those having a positive tone. This paper concludes with the discussion of theoretical and practical implications of the current findings.

A longitudinal analysis of electronic cigarette forum participation

Electronic cigarette (e-cigarette) Internet forums are social networking websites that allow members around the world to share information and personal experiences about e-cigarettes. However, little is known about their popularity and reach. This longitudinal study investigated indicators of participation (membership, number of discussion boards, and number of message posts) in 77 e-cigarette forums from February 2016 to January 2017. Autoregressive time-series analyses were used to assess monthly changes in participation among small (<1000 members), medium (1000-5000 members), and large (>5000 members) forums that were active at all 12 observation time points. Paired sample t-tests were conducted to compare changes in participation before and after the U.S. Food and Drug Administration announced the regulation of e-cigarettes. Analyses revealed significant and consistent increases in forum membership (R²s > 0.72; ps < 0.01), discussion boards (R²s > 0.97; ps < 0.001), and message posts (R²s > 0.96; ps < 0.001) across all forum sizes during the 12-month period. No differences were found in participation indicators pre- and post-regulation announcement. E-cigarette forums provide real-time information on the levels of participation over time and therefore may be an important platform to study interactions among consumers and how these interactions shape e-cigarette knowledge, attitudes and use behaviors.

Does Seeking e-Cigarette Information Lead to Vaping? Evidence from a National Longitudinal Survey of Youth and Young Adults

Youth and young adults (YYAs) are vulnerable populations for e-cigarette use or vaping. This study examined the effect of YYAs' health information seeking behavior (HISB) around e-cigarette use and vaping on their subsequent vaping behavior. We conducted a nationally representative longitudinal phone survey of 13-25 year olds from June 2014 to September 2016, with 2,413 respondents who completed a baseline and follow-up survey six months later. The results from lagged logistic regressions and mediation analyses showed a) that information seeking predicted higher likelihood of vaping six months later even after controlling for baseline smoking and vaping status, intention to vape, and demographics, and b) that information seeking partially mediated the relationship between intention to vape and subsequent vaping behavior. Theoretical and regulatory implications are discussed.

"Think it. Mix it. Vape it.": A Content Analysis on E-Cigarette Radio Advertisements

BACKGROUND

E-cigarette (EC) use is increasing rapidly across the United States, especially among youth. EC advertisements are one likely contributor to this increase, as they currently have few marketing restrictions. Radio advertising reaches most of the U.S. population and may be particularly influential in this regard.

OBJECTIVES

The purpose of the current study was to examine content themes and spending data from EC radio advertisements.

METHODS

Competitrack, a marketing tracking firm, gathered 19 advertisements from four different EC brands across the United States from 2015 to 2016, which were coded by two individuals and analyzed for main content themes. Additionally, spending data were analyzed by identified EC brand.

RESULTS

Logic was the most common EC brand advertised on the radio and included themes potentially appealing to youth, such as humor and sound effects. Of the 28 analyzed content themes, references to "taste" were the most popular, followed by highlighting benefits of using ECs, presence of music, and comparison to other EC brands. Only Logic advertisements (n = 7) included health disclaimers and age restriction messages, yet frequently included themes that were attractive to youth. Conclusions/Importance: As these radio advertisements are exposing youth and other vulnerable populations to ECs, regulations, similar to those made for conventional cigarette advertising, are necessary for prevention efforts.