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Li W, Zheng X, Li R, Lin HC. Differentiating the associations of passive and active social media use with e-cigarette use among U.S. youth. Addict Behav 2024; 158:108121. [PMID: 39096628 DOI: 10.1016/j.addbeh.2024.108121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE The impacts of passive (i.e., browsing) versus active (i.e., engagement) use of social media on e-cigarette use among youth have been understudied in existing literature. This study examines how passive and active use of social media are differentially associated with e-cigarette use among youth and how risk perceptions mediate these associations. METHODS Pooled data from the 2021 and 2022 National Youth Tobacco Survey (N=48,704, aged 11-19) were used. Weighted structural equation models were employed to estimate the associations between passive and active social media use and youth e-cigarette use. RESULTS Both passive and active social media use were associated with higher odds and more days of e-cigarette use among youth. E-cigarette risk perceptions mediated the associations between active use and both the likelihood of ever using e-cigarettes and the number of days of use. Risk perceptions mediated the association between active, but not passive, use and the number of days of e-cigarette use. Compared to passive use, active use was overall associated with higher odds and more days of youth e-cigarette use. DISCUSSION The findings suggest that public health efforts should distinguish between passive and active social media use when designing and executing interventions. Attention and efforts should also be directed towards understanding the distinct indirect effects of passive and active social media use through risk perceptions. These findings advance our theoretical understanding of the role of different types of social media use and offer significant practical insights for interventions.
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Affiliation(s)
- Wenbo Li
- School of Communication and Journalism, Stony Brook University, Melville Library N4004, Stony Brook, NY 11794, USA.
| | - Xia Zheng
- School of Communication and Journalism, Stony Brook University, Melville Library N4004, Stony Brook, NY 11794, USA
| | - Ruobing Li
- School of Communication and Journalism, Stony Brook University, Melville Library N4004, Stony Brook, NY 11794, USA
| | - Hsien-Chang Lin
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
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Sun T, Tattan-Birch H. Sports, Gigs, and TikToks: Multichannel Advertising of Oral Nicotine Pouches. Nicotine Tob Res 2024:ntae188. [PMID: 39191473 DOI: 10.1093/ntr/ntae188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/14/2024] [Accepted: 07/22/2024] [Indexed: 08/29/2024]
Abstract
This commentary highlights the aggressive advertising strategies being used to market oral nicotine pouches, including through online media, motorsport sponsorships, and out-of-home adverts. We underscore the need for balanced policy measures that maintain access to reduced harm alternatives for existing tobacco and nicotine users while minimizing exposure to youth and nonusers.
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Affiliation(s)
- Tianze Sun
- The National Centre for Youth Substance Use Research (NCYSUR), The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Harry Tattan-Birch
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, London, UK
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Olsson SE, Friedlich N, Bolds A, Hodge A, Jamali T, Lagomichos M. Exploring Menstrual Education via TikTok: A Descriptive Content Analysis. J Adolesc Health 2024; 75:353-357. [PMID: 38852086 DOI: 10.1016/j.jadohealth.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 03/16/2024] [Accepted: 04/11/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE TikTok has rapidly emerged as one of the foremost social media platforms for young adults and adolescents, becoming the most-downloaded app in 2022. With its broad reach across demographics, TikTok may be leveraged as a tool for teaching and destigmatizing topics such as menstruation. This study is the first to analyze the quality of menstruation-related content on TikTok. METHODS This cross-sectional study of TikTok videos and corresponding accounts examined six pre-determined menstruation-related hashtags in May 2023. Deductive qualitative analysis was performed between three coders to identify themes and content of the available videos. RESULTS A total of 140 videos created by 107 unique accounts were identified. The videos had varying purposes including audience education (66%), entertainment (35%), and product advertisement (17%). Videos mentioned various menstrual hygiene products, menstruation-related advice, and symptoms of menses. A vast majority of videos appeared to be created by laypersons with only 8% being led by health-care professionals. DISCUSSION With TikTok's usage as a social platform among youth, it displays potential as a tool to enhance menstrual education and destigmatization. There is a need for more menstruation experts to join the platform and provide quality material for users.
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Affiliation(s)
- Sofia Eva Olsson
- Anne Burnett Marion School of Medicine at Texas Christian University, Fort Worth, Texas.
| | - Nicole Friedlich
- Anne Burnett Marion School of Medicine at Texas Christian University, Fort Worth, Texas
| | - Alexis Bolds
- Anne Burnett Marion School of Medicine at Texas Christian University, Fort Worth, Texas
| | - Alison Hodge
- Anne Burnett Marion School of Medicine at Texas Christian University, Fort Worth, Texas
| | - Taylor Jamali
- Anne Burnett Marion School of Medicine at Texas Christian University, Fort Worth, Texas
| | - Melanie Lagomichos
- Anne Burnett Marion School of Medicine at Texas Christian University, Fort Worth, Texas
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Feng M, Binns S, Emery S. Exploring #MentholBan on TikTok: A Thematic and Semantic Network Analysis. Nicotine Tob Res 2024; 26:1022-1028. [PMID: 38381598 DOI: 10.1093/ntr/ntae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/10/2023] [Accepted: 02/17/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION In April 2021, the U.S. Food and Drug Administration (FDA) announced its intention to ban the sale of menthol cigarettes and cigars. Decades of research support the premise that a menthol ban will reduce initiation and disparities in tobacco-related disease among menthol smokers. The tobacco industry opposed such a policy and worked for decades to shape public opposition. Social media discourse can inform our understanding of public opinion about the proposed ban and guide communication strategies and policy implementation. AIMS AND METHODS This research employed a mixed-methods design to explore TikTok posts discussing the announced menthol ban. Using a TikTok web scraper to extract all content in the #mentholban hashtag (n = 171), we coded for 11 themes, characterized content with descriptive statistics, and created a semantic network of co-occurring hashtags. RESULTS We found primarily negative attitudes towards the U.S. ban announcement and a large volume of menthol "hacks" to circumvent the bans. Our semantic network analysis revealed strong co-occurrences between #mentholban and popularity-seeking hashtags. The metadata associated with each TikTok demonstrated that most posters in #mentholban are not "influencers" in the sense of having many followers, aside from a few niche organizations with multiple posts. We found that perceived political and racial motivations shaped posters' assessments of the menthol ban. Furthermore, we uncovered how individuals and organizational actors shaped menthol ban content on TikTok. CONCLUSIONS Our study indicates targeted marketing from alternative menthol product companies and advocacy organizations. The latter of these organizations is more likely to saturate the TikTok landscape with multiple posts and strategic hashtags. IMPLICATIONS This study pursued an exploration of tobacco policy discussion on TikTok, specifically related to the FDA-proposed menthol ban. TikTok is a newer platform and our study provides early evidence of policy discussion emerging there, including the types of accounts creating the content and their valence toward the policy.
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Affiliation(s)
- Miao Feng
- Social Data Collaboratory, Public Health, NORC at the University of Chicago, Chicago, IL, USA
| | - Steven Binns
- Social Data Collaboratory, Public Health, NORC at the University of Chicago, Chicago, IL, USA
| | - Sherry Emery
- Social Data Collaboratory, Public Health, NORC at the University of Chicago, Chicago, IL, USA
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Carpenter KA, Nguyen AT, Smith DA, Samori IA, Humphreys K, Lembke A, Kiang MV, Eichstaedt JC, Altman RB. Which Social Media Platforms Provide the Most Informative Data for Monitoring the Opioid Crisis? MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.06.24310035. [PMID: 39006412 PMCID: PMC11245080 DOI: 10.1101/2024.07.06.24310035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Background and Aims Social media can provide real-time insight into trends in substance use, addiction, and recovery. Prior studies have leveraged data from platforms such as Reddit and X (formerly Twitter), but evolving policies around data access have threatened their usability in opioid overdose surveillance systems. Here, we evaluate the potential of a broad set of platforms to detect emerging trends in the opioid crisis. Design We identified 72 online platforms with a substantial global user base or prior citations in opioid-related research. We evaluated each platform's fit with our definition of social media, size of North American user base, and volume of opioid-related discourse. We created a shortlist of 11 platforms that met our criteria. We documented basic characteristics, volume and nature of opioid discussion, official policies regulating drug-related discussion, and data accessibility of shortlisted platforms. Setting USA and Canada. Measurements We quantified the volume of opioid discussion by number of platform-specific Google search hits for opioid terms. We captured informal language by including slang generated using a large language model. We report the number of opioid-related hits and proportion of opioid-related hits to hits for common nouns. Findings We found that TikTok, YouTube, and Facebook have the most potential for use in opioid-related surveillance. TikTok and Facebook have the highest relative amount of drug-related discussions. Language on TikTok was predominantly informal. Many platforms offer data access tools for research, but changing company policies and user norms create instability. The demographics of users varies substantially across platforms. Conclusions Social media data sources hold promise for detecting trends in opioid use, but researchers must consider the utility, accessibility, and stability of data on each platform. A strategy mixing several platforms may be required to cover all demographics suffering in the epidemic.
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Leung J, Sun T, Vu G, Dawson D, Chan GCK. Promotions of vaping products near schools and central business district: A descriptive cross-sectional study. Health Promot J Austr 2024; 35:835-839. [PMID: 37608679 DOI: 10.1002/hpja.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
ISSUES ADDRESSED The increase of youth vaping in Australia has raised concerns, especially with increasing promotions of vaping products. We observed the visibility of vaping products near high-adolescent-traffic areas. METHODS We examined stores within walking distance of high schools and the central business district (CBD) in Brisbane, Australia, observing the number and proportion of stores selling or displaying vaping products. Using an observational approach, we analysed advertisements and open displays of vaping products at tobacconists, vape stores, and convenience stores. RESULTS We identified 61 eligible stores located near schools or in the CBD. Overall, 20% of stores displayed vaping products externally, with higher proportions among vape stores (78%) compared to tobacconists (36%). Additionally, 46% of stores had visible interior displays, with vape stores (89%) displaying them more frequently than tobacconists (71%). Among the 28 stores displaying vaping products, 57% included warnings, one store featured only flavoured products, and 25% showcased nicotine-containing products. Youth-appealing features were present in all but one store, with cartoons (61%) as the most common feature. CONCLUSION Vapes were displayed near high schools and in the city, often featuring youth-appealing features, such as colours and flavours. SO WHAT?: The exposure to such promotions could normalise vaping and contribute to increased youth uptake. Continued monitoring of vaping product promotions is essential, particularly considering recent policy changes.
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Affiliation(s)
- Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| | - Tianze Sun
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| | - Giang Vu
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| | - Danielle Dawson
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| | - Gary Chung Kai Chan
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
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Chen-Sankey J, Weiger C, La Capria K, Vassey J, Jeong M, Phan L, Unger JB, Allem JP, Berg CJ, Choi K. Young adults' visual attention to features of social media marketing for disposable e-cigarettes and associated perceptions. Addiction 2024. [PMID: 38923723 DOI: 10.1111/add.16586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/09/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND AND AIMS E-cigarette marketing exposure on social media influences perceptions; however, limited knowledge exists regarding marketing features attracting the most visual attention. This study examined visual attention to features of social media marketing for disposable e-cigarettes and related product perceptions. DESIGN, SETTING AND PARTICIPANTS Participants viewed 32 disposable marketing post images from social media (Instagram) using computer-based eye-tracking technology to assess standardized attention metrics of marketing features. They then completed a survey assessing positive product perceptions. The study took place in New Jersey, USA, June-September 2022, comprising young adults (aged 18-29) who do not use tobacco (n = 72) or who smoke cigarettes (n = 42). MEASUREMENTS We examined associations between 14 marketing features (e.g. product package, personal item, fruit/candy descriptor, social media account) and standardized attention metrics of dwell time (fixation duration) and entry time (time to first fixation). Then, we assessed attention metrics for each feature in relation to positive product perceptions (appeal and positive use expectancy). FINDINGS Among all participants, dwell time was the longest for the product descriptor [marginal means (MM) = 1.77; 95% confidence interval (CI) = 1.69, 1.86], social media account (MM = 1.76; 95% CI = 1.67, 1.85) and fruit/candy descriptor features (MM = 1.56; 95% CI = 1.41, 1.70); entry time was the shortest for the social media account (MM = 0.35; 95% CI = 0.26, 0.46), personal item (MM = 0.36; 95% CI = 0.17, 0.56) and human model features (MM = 0.40; 95% CI = 0.08, 0.72). Two use status groups had comparable dwell and entry times, except for the product descriptor feature. Longer dwell time for the product package feature increased positive product perceptions among both use status groups [regression coefficient (β) = 0.44 and 2.61]. Longer dwell time for fruit/candy descriptor (β = 1.80) and price promotion features (β = 4.04) increased positive product perceptions among those who smoke. CONCLUSIONS US young adults appear to be particularly visually engaged by disposable e-cigarette marketing that uses social media account features (account profile pictures, information about the products marketed and relevant hashtags) and features enhancing the products' personal relatability. Disposable product packages, fruit/candy descriptors and price promotions may increase the influence of social media marketing among various use status groups.
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Affiliation(s)
- Julia Chen-Sankey
- Rutgers University, Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, USA
- School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Caitlin Weiger
- Rutgers University, Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, USA
| | - Kathryn La Capria
- Rutgers University, Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, USA
| | - Julia Vassey
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michelle Jeong
- Rutgers University, Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, USA
- School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Lilianna Phan
- Dornsife School of Public Health and College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Jennifer B Unger
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jon-Patrick Allem
- Rutgers University, Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, USA
- School of Public Health, Rutgers University, Piscataway, NJ, USA
- Robert Wood Johnson Medical School, Division of General Internal Medicine, Rutgers University, New Brunswick, NJ, USA
| | - Carla J Berg
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute of Minority Health and Health Disparities, Bethesda, MD, USA
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Vogel EA, Ranker LR, Harrell PT, Hart JL, Kong G, McIntosh S, Meissner HI, Ozga JE, Romer D, Stanton CA. Characteristics of Adolescents' and Young Adults' Exposure to and Engagement with Nicotine and Tobacco Product Content on Social Media. JOURNAL OF HEALTH COMMUNICATION 2024; 29:383-393. [PMID: 38775659 PMCID: PMC11229177 DOI: 10.1080/10810730.2024.2355291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
To inform policy and messaging, this study examined characteristics of adolescents' and young adults' (AYAs') exposure to and engagement with nicotine and tobacco product (NTP) social media (SM) content. In this cross-sectional survey study, AYAs aged 13-26 (N=1,163) reported current NTP use, SM use frequency, and exposure to and engagement with SM content promoting and opposing NTP use (i.e. frequency, source[s], format[s], platform[s]). Participants who used NTPs (vs. did not use) were more likely to report having seen NTP content (p-values<.001). Prevalent sources were companies/brands (46.6%) and influencers (44.4%); prevalent formats were video (65.4%) and image (50.7%). Exposure to content promoting NTP use was prevalent on several popular platforms (e.g. TikTok, Instagram, Snapchat); exposure to content opposing NTP use was most prevalent on YouTube (75.8%). Among those reporting content engagement (i.e. liking, commenting on, or sharing NTP content; 34.6%), 57.2% engaged with influencer content. Participants reported engaging with content promoting and opposing NTP use on popular platforms (e.g. TikTok, Instagram, YouTube). Participants with (versus without) current NTP use were significantly more likely to use most SM platforms and to report NTP content exposure and engagement (p-values<.05). Results suggest that NTP education messaging and enforcement of platforms' content restrictions are needed.
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Affiliation(s)
- Erin A Vogel
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lynsie R Ranker
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Paul T Harrell
- Division of Community Health & Research, Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Joy L Hart
- Department of Communication, College of Arts and Sciences; Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Scott McIntosh
- Division of Social & Behavioral Sciences, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Helen I Meissner
- Office of Disease Prevention, National Institutes of Health, Bethesda, Maryland, USA
| | - Jenny E Ozga
- Behavioral Health & Health Policy, Westat, Rockville, Maryland, USA
| | - Dan Romer
- University of Pennsylvania Annenberg School for Communication, Philadelphia, Pennsylvania, USA
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Lee J, Ouellette RR, Morean ME, Kong G. Adolescents and Young Adults Use of Social Media and Following of e-Cigarette Influencers. Subst Use Misuse 2024; 59:1424-1430. [PMID: 38755112 DOI: 10.1080/10826084.2024.2352620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND With high rates of both e-cigarette and social media use among adolescents and young adults (AYAs), social media influencers who promote e-cigarettes are particularly concerning but are understudied. We examined the association between AYAs' use of 11 different social media platforms (e.g. Facebook, Twitter, Instagram, TikTok, and YouTube) and exposure to social media e-cigarette influencers. OBJECTIVES From November 2022 to February 2023, we conducted an online, US national survey of AYAs (14-29 years) who endorsed past-30-day e-cigarette use. We used binomial logistic regression to examine associations between the frequency of use of each social media platform and following e-cigarette influencers, controlling for age, sex, race, ethnicity, e-cigarette use frequency, and other tobacco and substance use (i.e., alcohol and cannabis). The model was stratified by adolescents (14-17 years; n = 293) and young adults (18-29 years; n = 654). RESULTS The most frequently used social media platforms were Snapchat, TikTok and Instagram among adolescents, and YouTube, Instagram and TikTok among young adults. In adjusted models, following e-cigarette influencers was associated with more frequent use of TikTok (adjusted odds ratio [95% CI]; 1.33 [1.05, 1.68]) and Pinterest (1.18 [1.02, 1.38]) among adolescents, and more frequent use of Twitter (1.17 [1.06, 1.29]) among young adults. CONCLUSIONS The use of different platforms was associated with exposure to e-cigarette influencers: TikTok and Pinterest among adolescents and Twitter among young adults. These findings can inform tobacco regulatory policy and social media platform restrictions of e-cigarette influencers on the platforms that are popular among AYAs.
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Affiliation(s)
- Juhan Lee
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rachel R Ouellette
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Meghan E Morean
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Grace Kong
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Beard TA, Donaldson SI, Unger JB, Allem JP. Examining Tobacco-Related Social Media Research in Government Policy Documents: Systematic Review. Nicotine Tob Res 2024; 26:421-426. [PMID: 37712553 PMCID: PMC10959066 DOI: 10.1093/ntr/ntad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/21/2023] [Accepted: 09/03/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Social media data have been used to describe tobacco industry marketing practices, user experiences with tobacco, and youth-oriented protobacco content. OBJECTIVE Examine the extent to which tobacco-related social media research is cited in government policy documents. SEARCH METHODS Peer-reviewed tobacco-related social media studies were searched for on Web of Science, PubMed, and other databases from 2004 to 2022. The DOI number for each identified article was then used to search the Overton database to find policy documents citing such research. A secondary, manual search of national and international governmental agency websites was also conducted. SELECTION CRITERIA Documents were included in this study if they were tobacco-related, written in English, cited social media research in the document text and reference section, and were published by a governmental office or agency. DATA COLLECTION AND ANALYSIS The analytic sample consisted of (n = 38) government policy documents, and were coded for content themes, agency type, document type, and subsequent citations. MAIN RESULTS When this research was utilized, it was often in the context of highlighting tobacco industry marketing practices, bringing attention to an issue (eg, youth e-cigarette use), and/or describing how social media platforms can be used as a data source to understand tobacco-related attitudes and behaviors. Agencies that often cited this research were the WHO, FDA, and CDC. The document types included research reports, policy recommendations, industry guidance, legal complaints, and practice-based recommendations. CONCLUSIONS Tobacco-related social media research has been utilized by government agencies in the last decade to guide the policy process. IMPLICATIONS Tobacco-related social media research has been used in government policy documents to detail tobacco industry marketing and bring attention to youth exposure to protobacco content online. Continued surveillance of social media may be necessary to track the changing tobacco landscape.
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Affiliation(s)
- Trista A Beard
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Scott I Donaldson
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jon-Patrick Allem
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Murthy D, Ouellette RR, Anand T, Radhakrishnan S, Mohan NC, Lee J, Kong G. Using Computer Vision to Detect E-cigarette Content in TikTok Videos. Nicotine Tob Res 2024; 26:S36-S42. [PMID: 38366342 PMCID: PMC10873490 DOI: 10.1093/ntr/ntad184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/15/2023] [Accepted: 09/27/2023] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Previous research has identified abundant e-cigarette content on social media using primarily text-based approaches. However, frequently used social media platforms among youth, such as TikTok, contain primarily visual content, requiring the ability to detect e-cigarette-related content across large sets of videos and images. This study aims to use a computer vision technique to detect e-cigarette-related objects in TikTok videos. AIMS AND METHODS We searched 13 hashtags related to vaping on TikTok (eg, #vape) in November 2022 and obtained 826 still images extracted from a random selection of 254 posts. We annotated images for the presence of vaping devices, hands, and/or vapor clouds. We developed a YOLOv7-based computer vision model to detect these objects using 85% of extracted images (N = 705) for training and 15% (N = 121) for testing. RESULTS Our model's recall value was 0.77 for all three classes: vape devices, hands, and vapor. Our model correctly classified vape devices 92.9% of the time, with an average F1 score of 0.81. CONCLUSIONS The findings highlight the importance of having accurate and efficient methods to identify e-cigarette content on popular video-based social media platforms like TikTok. Our findings indicate that automated computer vision methods can successfully detect a range of e-cigarette-related content, including devices and vapor clouds, across images from TikTok posts. These approaches can be used to guide research and regulatory efforts. IMPLICATIONS Object detection, a computer vision machine learning model, can accurately and efficiently identify e-cigarette content on a primarily visual-based social media platform by identifying the presence of vaping devices and evidence of e-cigarette use (eg, hands and vapor clouds). The methods used in this study can inform computational surveillance systems for detecting e-cigarette content on video- and image-based social media platforms to inform and enforce regulations of e-cigarette content on social media.
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Affiliation(s)
- Dhiraj Murthy
- Moody College of Communication, University of Texas at Austin, Austin, TX, USA
| | | | - Tanvi Anand
- Cockrell School of Engineering, University of Texas at Austin, Austin, TX, USA
| | - Srijith Radhakrishnan
- Department of Information and Communication Technology, Manipal Institute of Technology, Manipal, Karnataka, India
| | - Nikhil C Mohan
- Department of Information and Communication Technology, Manipal Institute of Technology, Manipal, Karnataka, India
| | - Juhan Lee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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12
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Stockings EA, Gardner LA, Newton NC. Vaping among young people-Our best defence is self-defence. Drug Alcohol Rev 2024; 43:355-358. [PMID: 37782572 DOI: 10.1111/dar.13746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/14/2023] [Accepted: 08/24/2023] [Indexed: 10/04/2023]
Abstract
Use of electronic cigarettes (e-cigarettes or 'vapes') has risen rapidly among young Australians in recent years. To combat this, on 2 May 2023, the Albanese Government announced a suite of reforms to reduce the desirability and accessibility of e-cigarettes to young people-including a ban on disposable e-cigarettes, restricting flavours, colours and nicotine content and requiring pharmaceutical-like packaging. While many have welcomed this announcement, the efficacy of such reforms in reducing the availability of e-cigarettes to young people remain to be seen, particularly given the current prescription-only model has done little to curb youth vaping. We argue that, in an uncertain landscape where e-cigarettes will likely remain accessible and desirable to young people, it is critical that we also upskill, empower and arm our young people with the skills, resilience, resources and knowledge to make informed and positive health decisions so that: (i) fewer young people opt to take up vaping (primary prevention); and (ii) among those who already do vape, more seek help earlier on to reduce or cease their use before dependency develops (secondary prevention). Schools are an ideal setting for the delivery of these programs, where they can be delivered en masse, integrated into existing alcohol and other drug programs and aligned with school curricula. Skills-based school prevention programs have demonstrated significant and sustained reductions in drug-related harms up to 7 years post-intervention. For as long as vapes remain widely available, desirable and purposefully marketed towards young people, we believe our best defence is self-defence.
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Affiliation(s)
- Emily A Stockings
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Lauren A Gardner
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Nicola C Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
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13
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Jancey J, Carey RN, Freeman B, Leaver T, Wolf K, Bromberg M, Chai K, Bialous S, Adams P, Mcleod M, McCausland K. E-cigarettes on Instagram: Exploring vape content via an Australian vaping influencer. Tob Induc Dis 2024; 22:TID-22-19. [PMID: 38250632 PMCID: PMC10798224 DOI: 10.18332/tid/175619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Mounting evidence suggests that electronic cigarettes (e-cigarettes) are extensively promoted and marketed using social media, including through user-generated content and social media influencers. This study explores how e-cigarettes are being promoted on Instagram, using a case-study approach, and the extent to which Meta's Restricted Goods and Services Policy (Meta's policy) is being applied and enforced. METHODS We identified the accounts followed by an Australian Instagram influencer who primarily posts e-cigarette-related content. The main foci of these 855 accounts were coded and 369 vaping-focused accounts were identified. These vaping-focused accounts were then further coded by two trained coders. RESULTS All (n=369; 100.0%) of the vape content posted by these accounts was positive in sentiment. One-third of the vape accounts (n=127; 34.4%) had a shared focus, indicating that vape content may permeate into other online communities through shared interests. A total of 64 accounts (17.3%) potentially violated Meta's policy by attempting to purchase, sell, raffle or gift e-cigarette products. CONCLUSIONS The findings of this study suggest that pro-vaping information is available and accessible on Instagram. Much of the content identified in this study promoted the purchase or gifting of e-cigarette products and potentially violates Meta's policy. Greater regulation and/or stronger enforcement of e-cigarette content on social media platforms such as Instagram is necessary to prevent the ongoing promotion of these harmful products.
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Affiliation(s)
- Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - Renee N. Carey
- School of Population Health, Curtin University, Bentley, Australia
| | - Becky Freeman
- School of Public Health, University of Sydney, Sydney, Australia
| | - Tama Leaver
- Internet Studies, School of Media, Creative Arts and Social Inquiry, Curtin University, Bentley, Australia
| | - Katharina Wolf
- School of Management and Marketing, Curtin University, Bentley, Australia
| | - Marilyn Bromberg
- Law School, The University of Western Australia, Crawley, Australia
| | - Kevin Chai
- School of Population Health, Curtin University, Bentley, Australia
| | - Stella Bialous
- School of Nursing, University of California, San Francisco, United States
| | - Phoebe Adams
- Collaboration for Evidence, Research and Impact in Public Health, Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - Meghan Mcleod
- Collaboration for Evidence, Research and Impact in Public Health, Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - Kahlia McCausland
- Collaboration for Evidence, Research and Impact in Public Health, Faculty of Health Sciences, Curtin University, Bentley, Australia
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14
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Chacon L, Mitchell G, Golder S. The commercial promotion of electronic cigarettes on social media and its influence on positive perceptions of vaping and vaping behaviours in Anglophone countries: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002736. [PMID: 38232105 DOI: 10.1371/journal.pgph.0002736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/30/2023] [Indexed: 01/19/2024]
Abstract
There is ongoing scientific and policy debate about the role e-cigarettes play in tobacco control, with concerns centring around unknown long-term effects, and the potential industry co-option of harm reduction efforts, including marketing to youths. There is substantial evidence of the influence of conventional cigarette promotion on smoking behaviours in Anglophone countries, and the popularity of social networking sites, as well as the lack of marketing regulations on the commercial promotion of electronic cigarettes online, suggest an urgent need to explore this topic further. This scoping review aims to map the existing evidence related to the influence of e-cigarette commercial promotion on social media on positive perceptions of vaping and vaping behaviours in core Anglophone countries. Searches were conducted in CENTRAL, Cochrane Database of Systematic Reviews (CDSR), Embase, Epistemonikos, MEDLINE, PsycINFO and Science Citation Index, on the 21st of July 2022. From 1,385 studies, 11 articles were included in the final review, using diverse study designs, including focus groups, content analysis, cross-sectional studies, and experiments. The studies were primarily based in the U.S. and evidenced the association between the commercial promotion of e-cigarettes on social media with positive perceptions of vaping and vaping behaviours, particularly among young people, addressing diverse themes including celebrities' sponsorship, e-liquid appeal (including flavours and nicotine levels), users' engagement with ads, and other marketing strategies. Further, social networking sites commercially promoting e-cigarettes might increase positive attitudes towards vaping and vaping behaviours, particularly among youths. Future research should be conducted in broader settings, incorporate larger and diverse sample sizes, ensure research transparency, cover multiple social networking sites, emphasize ecological validity, and foment longitudinal studies.
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Affiliation(s)
- L Chacon
- Department of Health Sciences, University of York, Heslington, United Kingdom
| | - G Mitchell
- Department of Health Sciences, University of York, Heslington, United Kingdom
| | - S Golder
- Department of Health Sciences, University of York, Heslington, United Kingdom
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15
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Johannes BL, Ortiz SE. How Facebook is used to promote ENDS products near four Big 10 universities: A qualitative analysis. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:210-218. [PMID: 35171078 PMCID: PMC9378756 DOI: 10.1080/07448481.2022.2027425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 11/04/2021] [Accepted: 12/26/2021] [Indexed: 06/14/2023]
Abstract
Objective: Electronic Nicotine Delivery System (ENDS) proprietors strategically placed near college campuses and pervasive marketing on social media platforms, such as Facebook, are critical to the tobacco industry's effort to acquire new young adult users. Understanding the themes used on Facebook to promote ENDS products to college students is necessary to develop public health messaging to combat the vaping epidemic.Methods: We identified 15 ENDS proprietors located near four Big 10 universities and qualitatively analyzed a random sample of their Facebook posts (n = 405) to identify emerging themes using a grounded theory approach.Results: ENDS proprietors in college towns use Facebook to deploy promotional messaging (n = 319), to market ENDS products as a means of celebration (n = 40), to establish a sense of community (n = 155) among ENDS users, to make marijuana references (n = 36), and to advocate (n = 27) for ENDS products.Conclusions: These themes may increase social acceptability and use of ENDS products among college students.
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Affiliation(s)
- Bobbie L. Johannes
- Population Studies Center, University of Michigan, Ann Arbor, United States
| | - S. E. Ortiz
- Department of Health Policy and Administration, Penn State University, University Park, United States
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16
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Whelan J, Noller GE, Ward RD. Rolling through TikTok: An analysis of 3,4-methylenedioxymethamphetamine-related content. Drug Alcohol Rev 2024; 43:36-44. [PMID: 36917507 DOI: 10.1111/dar.13640] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION TikTok has quickly gained popularity through its platforming of large amounts of short video content. Given its widespread popularity, unrestricted access and poor content monitoring may allow 3,4-methylenedioxymethamphetamine (MDMA)-related content to influence perception of MDMA use. We aimed to investigate how MDMA-related videos are portrayed on TikTok and explore MDMA-related harm reduction content. METHODS MDMA-related hashtags and sounds were utilised to collect data from TikTok (n = 498). Video views, likes, comments and shares were recorded and quantified, and videos were coded for depiction/sentiment towards MDMA and thematic content. RESULTS The total sample view count was 82,413,781. Videos had a median view count of 28,900 (SD = ±561,645), median like count of 2269 (SD = ±102,904), median comment count of 52 (SD = ±755), and median share count of 34 (SD = ±3292). Most videos depicted MDMA neutrally (40.6%), while 34.9% were positive. MDMA intoxication was presumed in 40.2% of videos. The analysis produced seven themes, of which humour was the most common (80.5%). Harm reduction content was present in nine videos, viewed 999,700 times, and consisted of mixed subject matter. DISCUSSION AND CONCLUSIONS Similar themes and issues surrounding drug-related content on TikTok are relevant to MDMA, and intoxication was present in a significant portion of the sample. Better monitoring or regulation of content could potentially offset harm that may arise from consumption of such content. Promotion of harm reduction content could also be trialled to minimise harm.
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Affiliation(s)
- Jai Whelan
- Department of Psychology, The University of Otago, Dunedin, New Zealand
| | - Geoffrey E Noller
- Bioethics Centre, Dunedin School of Medicine, The University of Otago, Dunedin, New Zealand
| | - Ryan D Ward
- Department of Psychology, The University of Otago, Dunedin, New Zealand
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17
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Sun T, Lim CCW, Rutherford BN, Johnson B, Connor J, Gartner CE, Hall WD, Leung J, Chan G. Changes in patterns of youth multiple tobacco and/or e-cigarette product use in the US between 2014 and 2020: a multiple-group latent class analysis. Tob Control 2023; 33:21-29. [PMID: 35667834 DOI: 10.1136/tobaccocontrol-2022-057266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/23/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Multiple tobacco and e-cigarette product (MTEP) use, the concurrent use of two or more different types of tobacco and/or e-cigarettes products, is common among young people in the US. Changes in patterns of MTEP use among US youth between 2014 and 2020 were identified and the determinants of MTEP use were examined. METHODS Four years of repeated cross-sectional data from the US National Youth Tobacco Survey of middle and high school students from grade 6 to 12 (Ntotal=77 402). Multigroup latent class analysis (LCA) was applied to the data series to allow for simultaneous identification of MTEP use patterns between 2014 and 2020. Logistic regression was used to predict class membership on demographic and tobacco-related variables. FINDINGS Over the 7-year period, LCA identified three patterns: minimal/non-users (MNU: ~89.8%), mostly occasional e-cigarette and cigarette users (MOEC: ~9%) and polytobacco users (POLY: ~1.2%). From 2014 to 2020, MNU increased from 86.4% to 92% (p<0.05), while MOEC and POLY decreased from 11.2% to 7.9% and from 2.4% to 0.1%, respectively. The probability of regular e-cigarette use increased from 0 to 2.3% among MNU, 6% to 31.9% among MOEC and 29.6% to 67.6% among POLY (p<0.05). In binomial logistic regression, being male, in high school, non-heterosexual, living with someone who uses tobacco at home, having cognitive difficulties, having lower perceptions of tobacco's danger and exposure to tobacco marketing were associated with greater odds of MOEC and POLY than MNU. CONCLUSIONS There was an increase in regular e-cigarette use in all three classes, but a corresponding decrease in the proportion of MTEP use. Public health interventions to discourage uptake of e-cigarettes, such as tighter restrictions on marketing to minors, are warranted and there is a need to consider disparities in the determinants of MTEP use.
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Affiliation(s)
- Tianze Sun
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, Herston, Queensland, Australia
| | - Carmen C W Lim
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, Herston, Queensland, Australia
| | - Brienna N Rutherford
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Benjamin Johnson
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Jason Connor
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Coral E Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, Herston, Queensland, Australia
| | - Wayne D Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Gary Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
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18
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Leung J, Lim C, McClure-Thomas C, Foo S, Sebayang S, Farassania G, Fausiah F, Gartner C, Chan GCK. Adolescent Exposure to Online Advertisements and Promotions for Tobacco Products on the Internet-A Cross-Sectional Analysis of the Global Youth Tobacco Surveys. J Adolesc Health 2023; 73:1138-1144. [PMID: 37737754 DOI: 10.1016/j.jadohealth.2023.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 05/04/2023] [Accepted: 07/07/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE Although many countries have banned tobacco advertising on traditional media platforms, the tobacco industry actively promotes their products via online channels. Adolescents are at high risk of exposure due to spending substantial time online. We examined the prevalence of adolescent exposure to online tobacco advertisements and promotions. METHODS We analyzed data from the Global Youth Tobacco Surveys (GYTS; 2013-2018; average response rate = 76.8%). We included 15 countries in four regions that measured self-reported exposure to tobacco advertising on the internet in the past month (N = 111,356, adolescents aged 11-18): Region of the Americas (Argentina, Costa Rica, Cuba, Ecuador, Panama, Paraguay, Peru), African (Mauritius, Zimbabwe), European (Czech Republic, Turkey), and the Western Pacific (Micronesia, Macao, Papua New Guinea, Samoa). We calculated the prevalence of online exposure to tobacco advertising by past-month cigarette use. RESULTS Prevalence of adolescent exposure to online advertisements for tobacco products ranged from 18.2%-34.3% and 12.3%-34.4% for tobacco advertisements that "looked fun or cool". Exposure to online tobacco product advertisements was prevalent across countries, including those with advertising bans in place, and included adolescents who have never smoked (14.4%-28.4% exposed to any, 9.1%-31.0% exposed to fun or cool advertisements). Reporting seeing tobacco advertising online that looked fun or cool was positively associated with the prevalence of past-month smoking (r = 0.64, p = .010). DISCUSSION A substantial proportion of adolescents in countries that have banned tobacco advertising are still exposed to advertisements for tobacco products online. Internet tobacco advertising needs better enforcement to prevent adolescent tobacco use and uptake worldwide.
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Affiliation(s)
- Janni Leung
- National Centre for Youth Substance Use Research, University of Queensland, Brisbane, Queensland, Australia; School of Psychology, University of Queensland, Brisbane, Queensland, Australia.
| | - Carmen Lim
- National Centre for Youth Substance Use Research, University of Queensland, Brisbane, Queensland, Australia; School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Caitlin McClure-Thomas
- National Centre for Youth Substance Use Research, University of Queensland, Brisbane, Queensland, Australia; School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Shaun Foo
- National Centre for Youth Substance Use Research, University of Queensland, Brisbane, Queensland, Australia
| | - Susy Sebayang
- School of Health and Life Sciences, Universitas Airlangga, Banyuwangi, Indonesia
| | - Ghea Farassania
- School of Psychology, Universitas Indonesia, Jakarta, Indonesia
| | - Fitri Fausiah
- School of Psychology, Universitas Indonesia, Jakarta, Indonesia
| | - Coral Gartner
- School of Public Heath, University of Queensland, Brisbane, Queensland, Australia
| | - Gary C K Chan
- National Centre for Youth Substance Use Research, University of Queensland, Brisbane, Queensland, Australia
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19
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Bautista M, Mogul AS, Fowler CD. Beyond the label: current evidence and future directions for the interrelationship between electronic cigarettes and mental health. Front Psychiatry 2023; 14:1134079. [PMID: 37645635 PMCID: PMC10460914 DOI: 10.3389/fpsyt.2023.1134079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
Electronic cigarette use has dramatically increased over the last decade. With this recent technological development and wide range of constituents in various products, putative adverse effects on the brain and body have been largely unexplored. Here, we review current evidence linking electronic nicotine cigarette use with potential health consequences and provide evidence supporting an association between drug use and depression in humans. We also examine the biological effects of individual constituents in electronic cigarette aerosols, which include labeled ingredients, such as propylene glycol, vegetable glycerin, nicotine, and flavorants, as well as unlabeled ingredients found in the aerosols, such as carbonyls and heavy metals. Lastly, we examine the effects of electronic cigarette use on endogenous metabolism via changes in cytochrome P450 enzymes, which can thereby impact therapeutic outcomes. While the current evidence offers insight into the potential effects of electronic cigarette use on biological processes, further studies are necessary to determine the long-term clinical relevance of aerosol inhalation.
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Affiliation(s)
| | | | - Christie D. Fowler
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, United States
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20
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Jancey J, Leaver T, Wolf K, Freeman B, Chai K, Bialous S, Bromberg M, Adams P, Mcleod M, Carey RN, McCausland K. Promotion of E-Cigarettes on TikTok and Regulatory Considerations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5761. [PMID: 37239490 PMCID: PMC10217796 DOI: 10.3390/ijerph20105761] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/22/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023]
Abstract
E-cigarettes are promoted extensively on TikTok and other social media platforms. Platform policies to restrict e-cigarette promotion seem insufficient and are poorly enforced. This paper aims to understand how e-cigarettes are being promoted on TikTok and provide insights into the effectiveness of current TikTok policies. Seven popular hashtag-based keywords were used to identify TikTok accounts and associated videos related to e-cigarettes. Posts were independently coded by two trained coders. Collectively, the 264 videos received 2,470,373 views, 166,462 likes and 3426 comments. The overwhelming majority of videos (97.7%) portrayed e-cigarettes positively, and these posts received 98.7% of the total views and 98.2% of the total likes. A total of 69 posts (26.1%) clearly violated TikTok's own content policy. The findings of the current study suggest that a variety of predominantly pro-vaping content is available on TikTok. Current policies and moderation processes appear to be insufficient in restricting the spread of pro-e-cigarette content on TikTok, putting predominantly young users at potential risk of e-cigarette use.
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Affiliation(s)
- Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Kent Street, Perth, WA 6102, Australia
| | - Tama Leaver
- Internet Studies, School of Media, Creative Arts and Social Inquiry, Curtin University, Kent Street, Perth, WA 6102, Australia
| | - Katharina Wolf
- School of Marketing, Curtin University, Kent Street, Perth, WA 6102, Australia
| | - Becky Freeman
- School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Kevin Chai
- School of Population Health, Curtin University, Kent Street, Perth, WA 6102, Australia
| | - Stella Bialous
- School of Nursing, University of California, San Francisco, CA 94158, USA
| | - Marilyn Bromberg
- UWA Law School, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Phoebe Adams
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Kent Street, Perth, WA 6102, Australia
| | - Meghan Mcleod
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Kent Street, Perth, WA 6102, Australia
| | - Renee N. Carey
- School of Population Health, Curtin University, Kent Street, Perth, WA 6102, Australia
| | - Kahlia McCausland
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Kent Street, Perth, WA 6102, Australia
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21
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Ayalde J, Ta D, Adesanya O, Mandzufas J, Lombardi K, Trapp G. Awake and Alert: Examining the Portrayal of Energy Drinks on TikTok. J Adolesc Health 2023; 72:633-635. [PMID: 36529617 DOI: 10.1016/j.jadohealth.2022.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Energy drinks (EDs) are not recommended for minors' consumption due to a myriad of health risks, but marketing initiatives persist. This study explored the promotion of EDs on TikTok, a platform frequented by children and adolescents. METHODS 197 highly viewed videos from the four top ED-related hashtags on TikTok were coded for engagement variables, user information, sponsorship status, video content, and sentiment toward EDs. RESULTS Of the 197 videos analyzed (combined 70 + million views), 29% disclosed sponsorship and 22% featured a child/adolescent. ED consumption appeared in 46% of videos, with 15% depicting hazardous consumption. Most videos (67%) had a positive sentiment toward EDs. DISCUSSION ED-related TikTok videos are positively framed, have high engagement, and are not restricted for viewing by minors. As the platform's underage user-base grows, such videos may encourage heightened consumption. Given the known health risks, effective age-gated content restrictions are needed to reduce minors' exposure.
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Affiliation(s)
- Jeremiah Ayalde
- Telethon Kids Institute, Nedlands, Western Australia, Australia; School of Medicine, The University of Western Australia, Nedlands, Western Australia, Australia.
| | - Daniel Ta
- Telethon Kids Institute, Nedlands, Western Australia, Australia; School of Medicine, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Olaoluwa Adesanya
- Telethon Kids Institute, Nedlands, Western Australia, Australia; School of Human Sciences, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Joelie Mandzufas
- Telethon Kids Institute, Nedlands, Western Australia, Australia; School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Karen Lombardi
- Telethon Kids Institute, Nedlands, Western Australia, Australia; School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Gina Trapp
- Telethon Kids Institute, Nedlands, Western Australia, Australia; School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia
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22
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Rutherford BN, Lim CCW, Johnson B, Cheng B, Chung J, Huang S, Sun T, Leung J, Stjepanović D, Chan GCK. #TurntTrending: a systematic review of substance use portrayals on social media platforms. Addiction 2023; 118:206-217. [PMID: 36075258 PMCID: PMC10087142 DOI: 10.1111/add.16020] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/21/2022] [Indexed: 01/05/2023]
Abstract
AIMS There is a growing body of literature exploring the types of substance-related content and their portrayals on various social media platforms. We aimed to summarize how content related to substances is portrayed on various social media platforms. METHODS This systematic review was pre-registered on PROSPERO (ref: CRD42021291853). A comprehensive search was conducted in the databases of PubMed, Scopus, PsycINFO and Web of Science in April 2021. Original qualitative studies published post-2004 that included thematic and sentiment analyses of social media content on tobacco, alcohol, psychostimulant, e-cigarette, cannabis, opiate, stimulant/amphetamine, inhalant and novel psychoactive substance were included. Social media platforms were defined as online web- or application-based platforms that allowed users to generate content and interact via 'liking', comment or messaging features. Only studies that included summative and/or thematic content analyses of substance-related social media content were included. RESULTS A total of 73 studies, which covered 15 905 182 substance-related posts on Twitter, YouTube, Instagram, Pinterest, TikTok and Weibo, were identified. A total of 76.3% of all substance-related content was positive in its depiction of substance use, with 20.2% of content depicting use negatively. Sentiment regarding opiate use however was commonly negative (55.5%). Most studies identified themes relating to Health, Safety and Harms (65.0%) of substance use. Themes relating to Promotions/Advertisements (63.3%), Informative content (55.0%) and Use behaviours (43.3%) were also frequently identified. CONCLUSIONS Substance-related content that promotes engagement with substance use or actively depicts use appears to be widely available on social media. The large public presence of this content may have concerning influences on attitudes, behaviours and risk perceptions relating to substance use, particularly among the most vulnerable and heaviest users of social media-adolescents and young adults.
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Affiliation(s)
- Brienna N Rutherford
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia.,School of Psychology, The University of Queensland, St Lucia, Australia
| | - Carmen C W Lim
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia.,School of Psychology, The University of Queensland, St Lucia, Australia
| | - Benjamin Johnson
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia.,School of Psychology, The University of Queensland, St Lucia, Australia
| | - Brandon Cheng
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia.,School of Psychology, The University of Queensland, St Lucia, Australia
| | - Jack Chung
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia.,School of Psychology, The University of Queensland, St Lucia, Australia
| | - Sandy Huang
- School of Medicine, The University of Queensland, St Lucia, Australia
| | - Tianze Sun
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia.,School of Psychology, The University of Queensland, St Lucia, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
| | - Daniel Stjepanović
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
| | - Gary C K Chan
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
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23
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Bagenal J, Zenone M, Maani N, Barbic S. Embracing the non-traditional: alcohol advertising on TikTok. BMJ Glob Health 2023; 8:bmjgh-2022-009954. [PMID: 36717153 PMCID: PMC9887687 DOI: 10.1136/bmjgh-2022-009954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 01/13/2023] [Indexed: 01/31/2023] Open
Affiliation(s)
- Jessamy Bagenal
- Masters in Public Health Programme, London School of Hygiene and Tropical Medicine, London, UK .,Editorial department, The Lancet, London, UK
| | - Marco Zenone
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK, UK
| | - Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Skye Barbic
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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24
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Mavragani A, Görig T, Vollstädt-Klein S, Grundinger N, Mons U, Lohner V, Schneider S, Andreas M. Addictive Potential of e-Cigarettes as Reported in e-Cigarette Online Forums: Netnographic Analysis of Subjective Experiences. J Med Internet Res 2023; 25:e41669. [PMID: 36607713 PMCID: PMC9862333 DOI: 10.2196/41669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND While e-cigarettes usually contain nicotine, their addictive potential is not yet fully understood. We hypothesized that if e-cigarettes are addictive, users will experience typical symptoms of addiction. OBJECTIVE The aim of our study was to investigate whether and how e-cigarette users report signs of addiction. METHODS We identified 3 large German-language e-cigarette online forums via a systematic Google search. Based on a netnographic approach, we used deductive content analysis to investigate relevant posts in these forums. Netnography has the advantage of limiting the social desirability bias that prevails in face-to-face research, such as focus groups. The data were coded according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for tobacco use disorder, adapted for e-cigarettes. The DSM-5 criteria were used to portray a broad spectrum of possible experiences of addiction. RESULTS Overall, 5337 threads in 3 forums were screened, and 451 threads containing relevant information were included in the analysis. Users reported experiences consistent with the DSM-5 criteria, such as craving e-cigarettes, excessive time spent vaping, and health issues related to e-cigarette use. However, our analysis also showed that users reported the absence of typical tobacco use disorder criteria, such as successful attempts to reduce the nicotine dosage. For most themes, reports of their absence were more frequent than of their presence. The absence of perceived addiction was mostly reported in contrast to prior tobacco smoking. CONCLUSIONS This is the first study to use a netnographic approach to explore unfiltered self-reports of experiences of e-cigarette addiction by users in online forums. As hypothesized, some but not all users reported subjective experiences that corresponded to the criteria of tobacco use disorder as defined by the DSM-5. Nevertheless, subjective reports also indicated that many e-cigarette users felt in control of their behavior, especially in contrast to their prior use of tobacco cigarettes. The finding that some e-cigarette users subjectively experience addiction highlights the need for effective cessation programs to support users who experience their e-cigarette use as burdensome. This research can guide the refinement of instruments to assess e-cigarette addiction and guide cessation programs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s40359-021-00682-8.
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Affiliation(s)
| | - Tatiana Görig
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany.,Mannheim Center for Translational Neurosciences, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nadja Grundinger
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ute Mons
- Cardiovascular Epidemiology of Aging, Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Valerie Lohner
- Cardiovascular Epidemiology of Aging, Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sven Schneider
- Division of Public Health, Social and Preventive Medicine, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marike Andreas
- Division of Public Health, Social and Preventive Medicine, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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25
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Scheffels J, Tokle R, Linnansaari A, Rasmussen SKB, Pisinger C. E-cigarette use in global digital youth culture. A qualitative study of the social practices and meaning of vaping among 15-20-year-olds in Denmark, Finland, and Norway. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103928. [PMID: 36527908 DOI: 10.1016/j.drugpo.2022.103928] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The introduction of e-cigarettes on the tobacco market has brought new regulatory challenges, and particular concerns relate to e-cigarette uptake among young people. The aim of this study was to explore the use and social meaning of e-cigarettes among Nordic young people and to discuss this in the context of current legislation. METHODS Thirteen focus groups were conducted with 46 Danish, Finnish, and Norwegian young people (24 boys) with vaping experience aged 15-20 years (mean age 17 years). RESULTS Young people's vaping stood out as an inherently social practice that was commonly interlinked with experimental use patterns. Relative to smoking, vaping was seen as socially acceptable and less harmful to health. Product innovations like flavour additives and nicotine-free liquid options added to perceptions of low harm, and innovative device design features facilitated new and playful user practices. Finally, digital markets eased the young people's access to e-cigarettes, and the digital world also represented an arena for e-cigarette exposure and self-presentation. They commonly viewed vaping-related content in their social media feeds and also produced such content themselves. CONCLUSION Young people's vaping is a social practice interwoven in contemporary digital and global youth culture. Transnational regulations are needed to support individual countries in preventing e-cigarette use and exposure among young people.
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Affiliation(s)
- Janne Scheffels
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, Oslo, Norway.
| | - Rikke Tokle
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, Oslo, Norway; Norwegian Social Research, Oslo Metropolitan University, Oslo, Norway
| | - Anu Linnansaari
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Finland
| | - Sofie K B Rasmussen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Danish Heart Foundation, Copenhagen, Denmark
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26
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Vassey J, Galimov A, Kennedy CJ, Vogel EA, Unger JB. Frequency of Social Media Use and Exposure to Tobacco or Nicotine-Related Content in Association with E-cigarette Use Among Youth: A Cross-Sectional and Longitudinal Survey Analysis. Prev Med Rep 2022; 30:102055. [DOI: 10.1016/j.pmedr.2022.102055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 11/16/2022] Open
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27
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Vassey J, Donaldson S, Dormanesh A, Allem JP. THEMES IN TIKTOK VIDEOS FEATURING LITTLE CIGARS AND CIGARILLOS: A CONTENT ANALYSIS (Preprint). J Med Internet Res 2022; 24:e42441. [DOI: 10.2196/42441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/05/2022] Open
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28
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Greene AK, Carr S, Jia H. Tech, Sex, and E-cigarettes: The Gendering of Vape Promotion on Instagram. JOURNAL OF HEALTH COMMUNICATION 2022; 27:682-695. [PMID: 36420804 DOI: 10.1080/10810730.2022.2150336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The promotion of vape products on social media has been implicated in increasing rates of e-cigarette usage, particularly among youth and young adults. While research has examined overall trends in vape-related content across a number of platforms, the role that social media "influencers" play in promoting vaping and potentially augmenting this public health crisis has been insufficiently explored. The present study examined 44,052 Instagram posts by 60 male presenting and 60 female presenting vape influencers to understand how influencer gender mediates the performance of vape culture online. Our textual and visual analysis of these influencers' posts over one year revealed significant bifurcations based on gender. Independent sample t-tests showed statistically significant gender differences in word frequency. Male-presenting influencers tended to emphasize their expertise with vape devices as technologies, while female-presenting influencers tended to focus on their own appearance. Further, factor analysis indicated six major categories of textual features, and multiple linear regression tests showed varying levels of user engagement with the different categories across both genders. Chi-square tests indicated that female-presenting influencers highlighted their own bodies in the visual content of their posts, whereas male presenting influencers often posted images of vape devices or their component parts alone. These findings suggest that gender presentation plays an important role in shaping vape influencers' promotional tactics and vape-related content on Instagram, and also provides insights into what kinds of content receive the most user engagement. This study can therefore help inform interventions to mitigate the impact of social media vape promotion.
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Affiliation(s)
- Amanda K Greene
- Center for Bioethics and Social Sciences in Medicine(CBSSM), University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Shelby Carr
- Department of English Language & Literature, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Haiyan Jia
- Department of Journalism and Communication, Lehigh University, Bethlehem, Pennsylvania, USA
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29
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Xie Z, Xue S, Gao Y, Li D. Characterizing Electronic Cigarette-Related Videos on TikTok: Observational Study (Preprint). JMIR Form Res 2022; 7:e42346. [PMID: 37018026 PMCID: PMC10131997 DOI: 10.2196/42346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/19/2023] [Accepted: 02/20/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND As a popular social networking platform for sharing short videos, TikTok has been widely used for sharing e-cigarettes or vaping-related videos, especially among the youth. OBJECTIVE This study aims to characterize e-cigarette or vaping-related videos and their user engagement on TikTok through descriptive analysis. METHODS From TikTok, a total of 417 short videos, posted between October 4, 2018, and February 27, 2021, were collected using e-cigarette or vaping-related hashtags. Two human coders independently hand-coded the video category and the attitude toward vaping (provaping or antivaping) for each vaping-related video. The social media user engagement measures (eg, the comment count, like count, and share count) for each video category were compared within provaping and antivaping groups. The user accounts posting these videos were also characterized. RESULTS Among 417 vaping-related TikTok videos, 387 (92.8%) were provaping, and 30 (7.2%) were antivaping videos. Among provaping TikTok videos, the most popular category is vaping tricks (n=107, 27.65%), followed by advertisement (n=85, 21.95%), customization (n=75, 19.38%), TikTok trend (n=70, 18.09%), others (n=44, 11.37%), and education (n=6, 1.55%). By comparison, videos showing the TikTok trend had significantly higher user engagement (like count per video) than other provaping videos. Antivaping videos included 15 (50%) videos with the TikTok trend, 10 (33.33%) videos on education, and 5 (16.67%) videos about others. Videos with education have a significantly lower number of likes than other antivaping videos. Most TikTok users posting vaping-related videos are personal accounts (119/203, 58.62%). CONCLUSIONS Vaping-related TikTok videos are dominated by provaping videos focusing on vaping tricks, advertisement, customization, and TikTok trend. Videos with the TikTok trend have higher user engagement than other video categories. Our findings provide important information on vaping-related videos shared on TikTok and their user engagement levels, which might provide valuable guidance on future policy making, such as possible restrictions on provaping videos posted on TikTok, as well as how to effectively communicate with the public about the potential health risks of vaping.
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Affiliation(s)
- Zidian Xie
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Siyu Xue
- Goergen Institute for Data Science, University of Rochester, Rochester, NY, United States
| | - Yankun Gao
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Dongmei Li
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
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30
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Marynak KL, Robichaud MO, Puryear T, Kennedy RD, Moran MB. #Nicotineaddiction on TikTok: A quantitative content analysis of top-viewed posts. Tob Induc Dis 2022; 20:69. [PMID: 35979474 PMCID: PMC9353672 DOI: 10.18332/tid/151868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/15/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION TikTok, the video-sharing app popular among youth, is a source of user-generated content about nicotine addiction with the potential to endorse or deter nicotine use among young viewers. We systematically analyzed content and themes of TikTok posts tagged #nicotineaddiction. METHODS We conducted a quantitative content analysis of the visual and textual content of the 149 top-viewed English-language TikTok posts tagged #nicotineaddiction as of 1 March 2021. Posts were double-coded using a shared codebook, noting content creator characteristics, nicotine products featured, references to quitting, and overall themes of #nicotineaddiction expressed. We assessed the prevalence of post characteristics and themes overall and by apparent age of content creators (aged ≥21 years versus <21 years). RESULTS The 149 posts analyzed received a mean and median of 62433 and 15800 likes, respectively. E-cigarettes were referenced or featured in 75% of posts; 58% featured a specific nicotine product brand, most commonly Puff Bar (23% of total) and JUUL (19%). Overall, 22% of posts mentioned quitting nicotine. The top themes of #nicotineaddiction expressed were physical or psychological consequences (e.g. withdrawal symptoms, 46%), physical or psychological benefits (e.g. tasting good, feeling ‘buzzed’, 28%), and social benefits (e.g. bonding with fellow users, 28%). Compared to those aged ≥21 years, posts by content creators likely <21 years (26%) less commonly mentioned quitting (p<0.01), had fewer followers (p<0.01), were more commonly from Canada (p<0.01) and less commonly from the US (p<0.01), and more commonly featured JUUL (p<0.05). CONCLUSIONS While reaching a large and engaged audience, TikTok content creators suggest a range of benefits and consequences of nicotine addiction. Future research is warranted to examine this content’s potential to influence young people’s intentions to use or quit nicotine products.
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Affiliation(s)
- Kristy L. Marynak
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Meagan O. Robichaud
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Tyler Puryear
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Ryan D. Kennedy
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Meghan B. Moran
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
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Personality Traits and Sociodemographic Factors Associated with the Use of E-Cigarettes, Waterpipe and Conventional Cigarettes among Medical University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127000. [PMID: 35742249 PMCID: PMC9222766 DOI: 10.3390/ijerph19127000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 12/04/2022]
Abstract
This study aimed to investigate the prevalence and sociodemographic characteristics of smokers in a private medical university in Malaysia and to examine whether there is an association between personality traits and various smoking types. There were 468 participants in this study and the mean age was 20.97 years (±2.743). The prevalence of conventical cigarette users, e-cigarette users, and water pipe users was 4.7%, 6.4%, and 4.0%, respectively. Parents’ annual income (p = 0.001) and ethnicity (p < 0.001) were significantly associated with the current smoker group. Binary logistic regression modelling revealed that study participants with either Malay (OR 4.23, 95% CI 1.73, 10.34) or Chinese (OR 4.16, 95% CI 1.98, 8.73) ethnicity were approximately four times more likely to use tobacco products compared with study participants with Indian and Other ethnicities. Lower parents’ annual income was almost four times more likely to be associated with smoking behaviour (OR 3.82, 95% CI 1.58, 9.27). Significant differences in mean personality traits score of Openness (p = 0.018) and Extraversion (p = 0.004) were observed between never-smoker and current smoker study participants. In addition, cigarette users scored higher in Conscientiousness personality traits compared with non-cigarette whereas e-cigarette users and waterpipe users scored lower in Extraversion (p = 0.02). Post-hoc analysis revealed that the never-smoker group scored higher in Extraversion compared with the dual tobacco user group (p = 0.03). In addition, the single tobacco user group scored higher in Agreeableness personality trait compared with the never-smoker group (p = 0.01). Deeper understanding of the different cognitive dimensions, ethnicities, and educational backgrounds can potentially impact smoking prevention and cessation programs.
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32
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Brooks R, Christidis R, Carah N, Kelly B, Martino F, Backholer K. Turning users into 'unofficial brand ambassadors': marketing of unhealthy food and non-alcoholic beverages on TikTok. BMJ Glob Health 2022; 7:bmjgh-2022-009112. [PMID: 35879104 PMCID: PMC9240823 DOI: 10.1136/bmjgh-2022-009112] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/02/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction TikTok has over one billion monthly users and is particularly popular among children. We examined the (1) use of owned media by major unhealthy food and non-alcoholic beverage brands on TikTok and (2) nature of branded hashtag challenges instigated by such brands and the user-generated content created in response. Methods We assessed the (1) content of all videos posted on the accounts of 16 top food and non-alcoholic beverage brands (based on global brand share) as at 30 June 2021, and (2) content and sentiment of a sample of brand-relevant user-generated content created in response to branded hashtag challenges instigated by these brands. Results Of 539 videos posted by brands, 60% were posted in the first half of 2021. The most common marketing strategies were branding (87% of videos), product images (85%), engagement (31%) and celebrities/influencers (25%). Engagement included instigation of branded hashtag challenges that encouraged creation of user-generated content featuring brands’ products, brands’ videos and/or branded effects. The total collective views of user-generated content from single challenges ranged from 12.7 million to 107.9 billion. Of a sample of 626 brand-relevant videos generated in response to these challenges, 96% featured branding, 68% product images and 41% branded effects. Most portrayed a positive (73%) or neutral/unclear (25%) sentiment, with few negative (3%). Conclusion Unhealthy food and non-alcoholic beverage brands are using TikTok to market brands and products via their own accounts and to encourage users to create and share their own content that features branding and product images. Given TikTok’s popularity among children, this study supports the need for policies that protect children from the harmful impact of food marketing on social networking platforms.
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Affiliation(s)
- Ruby Brooks
- Global Obesity Centre, Deakin University, Geelong, Victoria, Australia
| | | | - Nicholas Carah
- School of Communication and Arts, University of Queensland, Brisbane, Queensland, Australia
| | - Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | | | - Kathryn Backholer
- Global Obesity Centre, Deakin University, Geelong, Victoria, Australia
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33
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Purushothaman V, McMann T, Nali M, Li Z, Cuomo R, Mackey TK. Content Analysis of Nicotine Poisoning (Nic Sick) Videos on TikTok: Retrospective Observational Infodemiology Study. J Med Internet Res 2022; 24:e34050. [PMID: 35353056 PMCID: PMC9008518 DOI: 10.2196/34050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 12/24/2022] Open
Abstract
Background TikTok is a microvideo social media platform currently experiencing rapid growth and with 60% of its monthly users between the ages of 16 and 24 years. Increased exposure to e-cigarette content on social media may influence patterns of use, including the risk of overconsumption and possible nicotine poisoning, when users engage in trending challenges online. However, there is limited research assessing the characteristics of nicotine poisoning–related content posted on social media. Objective We aimed to assess the characteristics of content on TikTok that is associated with a popular nicotine poisoning–related hashtag. Methods We collected TikTok posts associated with the hashtag #nicsick, using a Python programming package (Selenium) and used an inductive coding approach to analyze video content and characteristics of interest. Videos were manually annotated to generate a codebook of the nicotine sickness–related themes. Statistical analysis was used to compare user engagement characteristics and video length in content with and without active nicotine sickness TikTok topics. Results A total of 132 TikTok videos associated with the hashtag #nicsick were manually coded, with 52.3% (69/132) identified as discussing firsthand and secondhand reports of suspected nicotine poisoning symptoms and experiences. More than one-third of nicotine poisoning–related content (26/69, 37.68%) portrayed active vaping by users, which included content with vaping behavior such as vaping tricks and overconsumption, and 43% (30/69) of recorded users self-reported experiencing nicotine sickness, poisoning, or adverse events such as vomiting following nicotine consumption. The average follower count of users posting content related to nicotine sickness was significantly higher than that for users posting content unrelated to nicotine sickness (W=2350.5, P=.03). Conclusions TikTok users openly discuss experiences, both firsthand and secondhand, with nicotine adverse events via the #nicsick hashtag including reports of overconsumption resulting in sickness. These study results suggest that there is a need to assess the utility of digital surveillance on emerging social media platforms for vaping adverse events, particularly on sites popular among youth and young adults. As vaping product use-patterns continue to evolve, digital adverse event detection likely represents an important tool to supplement traditional methods of public health surveillance (such as poison control center prevalence numbers).
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Affiliation(s)
- Vidya Purushothaman
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Anesthesiology and Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States
| | - Tiana McMann
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Anthropology, University of California San Diego, La Jolla, CA, United States.,S-3 Research, San Diego, CA, United States
| | - Matthew Nali
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Anesthesiology and Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States.,S-3 Research, San Diego, CA, United States
| | - Zhuoran Li
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Anthropology, University of California San Diego, La Jolla, CA, United States.,S-3 Research, San Diego, CA, United States
| | - Raphael Cuomo
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Anesthesiology and Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States
| | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Anthropology, University of California San Diego, La Jolla, CA, United States.,S-3 Research, San Diego, CA, United States
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#NicotineAddictionCheck: Puff Bar Culture, Addiction Apathy, and Promotion of E-Cigarettes on TikTok. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031820. [PMID: 35162846 PMCID: PMC8835227 DOI: 10.3390/ijerph19031820] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023]
Abstract
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.
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35
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Rutherford BN, Sun T, Johnson B, Co S, Lim TL, Lim CCW, Chiu V, Leung J, Stjepanovic D, Connor JP, Chan GCK. Getting high for likes: Exploring cannabis‐related content on
TikTok. Drug Alcohol Rev 2022; 41:1119-1125. [DOI: 10.1111/dar.13433] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Brienna N. Rutherford
- National Centre for Youth Substance Use Research The University of Queensland Brisbane Australia
- School of Psychology The University of Queensland Brisbane Australia
| | - Tianze Sun
- National Centre for Youth Substance Use Research The University of Queensland Brisbane Australia
- School of Psychology The University of Queensland Brisbane Australia
| | - Benjamin Johnson
- National Centre for Youth Substance Use Research The University of Queensland Brisbane Australia
- School of Psychology The University of Queensland Brisbane Australia
| | - Steven Co
- National Centre for Youth Substance Use Research The University of Queensland Brisbane Australia
- School of Psychology The University of Queensland Brisbane Australia
| | - Tong Liang Lim
- University Hospitals of Leicester NHS Trust Leicester UK
| | - Carmen C. W. Lim
- National Centre for Youth Substance Use Research The University of Queensland Brisbane Australia
- School of Psychology The University of Queensland Brisbane Australia
| | - Vivian Chiu
- National Centre for Youth Substance Use Research The University of Queensland Brisbane Australia
- School of Psychology The University of Queensland Brisbane Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research The University of Queensland Brisbane Australia
- School of Psychology The University of Queensland Brisbane Australia
- National Drug and Alcohol Research Centre UNSW Sydney Sydney Australia
| | - Daniel Stjepanovic
- National Centre for Youth Substance Use Research The University of Queensland Brisbane Australia
- School of Psychology The University of Queensland Brisbane Australia
| | - Jason P. Connor
- National Centre for Youth Substance Use Research The University of Queensland Brisbane Australia
- Discipline of Psychiatry The University of Queensland Brisbane Australia
| | - Gary C. K. Chan
- National Centre for Youth Substance Use Research The University of Queensland Brisbane Australia
- School of Psychology The University of Queensland Brisbane Australia
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Rutherford BN, Sun T, Lim CCW, Chung J, Cheng B, Davidson L, Tisdale C, Leung J, Stjepanović D, Connor JP, Chan GCK. Changes in Viewer Engagement and Accessibility of Popular Vaping Videos on TikTok: A 12-Month Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031141. [PMID: 35162170 PMCID: PMC8834819 DOI: 10.3390/ijerph19031141] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 02/05/2023]
Abstract
AIM There are concerns regarding what young people are exposed to on TikTok due to trending content promoting e-cigarette use through humour, marketing and lifestyle acceptability. Using baseline data from November 2020, we aimed to examine how much content from a sample of popular vaping videos remained accessible at 9- and 12-month follow-ups. We aimed to monitor changes in viewer engagement (using metadata) before and after the U.S. Congressional Hearing on youth protection measures on social media in October 2021. METHODS Hashtag-based keywords were used to collect the most viewed publicly available e-cigarette related videos on TikTok (N = 802) from inception to November 2020 to form a baseline. Researchers conducted a longitudinal descriptive study using this data, with 9- and 12-month follow-ups to measure changes in viewer engagement (using metadata) and content availability. FINDINGS Of the 802 videos from the baseline, 562 remained at the 9-month follow-up and 511 remained at the 12-month follow-up. At the 12-month follow-up, the majority of vaping-related hashtags were removed by TikTok after the Congressional Hearing. Between the baseline and 9-month follow up, views increased by 1.4% and likes increased by 4.4%. At 12-month follow-up, views had increased by 1.7% and likes by 4.2% compared to baseline data. Whilst 291 videos were no longer publicly accessible at 12-month follow-up, 39 of these were made inaccessible by the content creators. The most viewed and most liked vaping videos at baseline were still publicly available. CONCLUSIONS Whilst the depiction type and thematic distribution of removed videos suggest that TikTok may be removing a small proportion of content that promotes the use of e-cigarettes, metadata of remaining videos indicate an increase in viewer engagement. TikTok's removal of explicit substance-related hashtags from the platform could be a step towards preventing adolescents from being exposed to harmful behaviours and substances online. However, the platform should consider enforcing effective age restrictions on content that promotes substance use in a positive light.
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Affiliation(s)
- Brienna N. Rutherford
- National Centre for Youth Substance Use Research, The University of Queensland, St. Lucia 4067, Australia; (T.S.); (C.C.W.L.); (J.C.); (B.C.); (J.L.); (D.S.); (J.P.C.); (G.C.K.C.)
- School of Psychology, The University of Queensland, St. Lucia 4067, Australia; (L.D.); (C.T.)
- Correspondence:
| | - Tianze Sun
- National Centre for Youth Substance Use Research, The University of Queensland, St. Lucia 4067, Australia; (T.S.); (C.C.W.L.); (J.C.); (B.C.); (J.L.); (D.S.); (J.P.C.); (G.C.K.C.)
- School of Psychology, The University of Queensland, St. Lucia 4067, Australia; (L.D.); (C.T.)
| | - Carmen C. W. Lim
- National Centre for Youth Substance Use Research, The University of Queensland, St. Lucia 4067, Australia; (T.S.); (C.C.W.L.); (J.C.); (B.C.); (J.L.); (D.S.); (J.P.C.); (G.C.K.C.)
- School of Psychology, The University of Queensland, St. Lucia 4067, Australia; (L.D.); (C.T.)
| | - Jack Chung
- National Centre for Youth Substance Use Research, The University of Queensland, St. Lucia 4067, Australia; (T.S.); (C.C.W.L.); (J.C.); (B.C.); (J.L.); (D.S.); (J.P.C.); (G.C.K.C.)
- School of Psychology, The University of Queensland, St. Lucia 4067, Australia; (L.D.); (C.T.)
| | - Brandon Cheng
- National Centre for Youth Substance Use Research, The University of Queensland, St. Lucia 4067, Australia; (T.S.); (C.C.W.L.); (J.C.); (B.C.); (J.L.); (D.S.); (J.P.C.); (G.C.K.C.)
- School of Psychology, The University of Queensland, St. Lucia 4067, Australia; (L.D.); (C.T.)
| | - Lily Davidson
- School of Psychology, The University of Queensland, St. Lucia 4067, Australia; (L.D.); (C.T.)
| | - Calvert Tisdale
- School of Psychology, The University of Queensland, St. Lucia 4067, Australia; (L.D.); (C.T.)
| | - Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, St. Lucia 4067, Australia; (T.S.); (C.C.W.L.); (J.C.); (B.C.); (J.L.); (D.S.); (J.P.C.); (G.C.K.C.)
- School of Psychology, The University of Queensland, St. Lucia 4067, Australia; (L.D.); (C.T.)
- National Drug and Alcohol Research Centre, University of New South Wales, Kensington 2033, Australia
| | - Daniel Stjepanović
- National Centre for Youth Substance Use Research, The University of Queensland, St. Lucia 4067, Australia; (T.S.); (C.C.W.L.); (J.C.); (B.C.); (J.L.); (D.S.); (J.P.C.); (G.C.K.C.)
- School of Psychology, The University of Queensland, St. Lucia 4067, Australia; (L.D.); (C.T.)
| | - Jason P. Connor
- National Centre for Youth Substance Use Research, The University of Queensland, St. Lucia 4067, Australia; (T.S.); (C.C.W.L.); (J.C.); (B.C.); (J.L.); (D.S.); (J.P.C.); (G.C.K.C.)
- Discipline of Psychiatry, The University of Queensland, Herston 4006, Australia
| | - Gary C. K. Chan
- National Centre for Youth Substance Use Research, The University of Queensland, St. Lucia 4067, Australia; (T.S.); (C.C.W.L.); (J.C.); (B.C.); (J.L.); (D.S.); (J.P.C.); (G.C.K.C.)
- School of Psychology, The University of Queensland, St. Lucia 4067, Australia; (L.D.); (C.T.)
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Shah N, Nali M, Bardier C, Li J, Maroulis J, Cuomo R, Mackey TK. Applying topic modelling and qualitative content analysis to identify and characterise ENDS product promotion and sales on Instagram. Tob Control 2021:tobaccocontrol-2021-056937. [PMID: 34857646 DOI: 10.1136/tobaccocontrol-2021-056937] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/16/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Increased public health and regulatory scrutiny concerning the youth vaping epidemic has led to greater attention to promotion and sales of vaping products on social media platforms. OBJECTIVES We used unsupervised machine learning to identify and characterise sale offers of electronic nicotine delivery systems (ENDS) and associated products on Instagram. We examined types of sellers, geographic ENDS location and use of age verification. METHODS Our methodology was composed of three phases: data collection, topic modelling and content analysis. We used data mining approaches to query hashtags related to ENDS product use among young adults to collect Instagram posts. For topic modelling, we applied an unsupervised machine learning approach to thematically categorise and identify topic clusters associated with selling activity. Content analysis was then used to characterise offers for sale of ENDS products. RESULTS From 70 725 posts, we identified 3331 engaged in sale of ENDS products. Posts originated from 20 different countries and were roughly split between individual (46.3%) and retail sellers (43.4%), with linked online sellers (8.8%) representing a smaller volume. ENDS products most frequently offered for sale were flavoured e-liquids (53.0%) and vaping devices (20.5%). Online sellers offering flavoured e-liquids were less likely to use age verification at point of purchase (29% vs 64%) compared with other products. CONCLUSIONS Instagram is a global venue for unregulated ENDS sales, including flavoured products, and access to websites lacking age verification. Such posts may violate Instagram's policies and US federal and state law, necessitating more robust review and enforcement to prevent ENDS uptake and access.
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Affiliation(s)
- Neal Shah
- Department of Healthcare Research and Policy, University of California San Diego, La Jolla, California, USA.,Global Health Policy and Data Institute, San Diego, California, USA
| | - Matthew Nali
- Global Health Policy and Data Institute, San Diego, California, USA.,Department of Anesthesiology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Cortni Bardier
- Global Health Policy and Data Institute, San Diego, California, USA.,Global Health Program, Department of Anthropology, University of California San Diego, La Jolla, California, USA
| | - Jiawei Li
- Global Health Policy and Data Institute, San Diego, California, USA
| | - James Maroulis
- Global Health Program, Department of Anthropology, University of California San Diego, La Jolla, California, USA
| | - Raphael Cuomo
- Global Health Policy and Data Institute, San Diego, California, USA.,Department of Anesthesiology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Tim K Mackey
- Department of Healthcare Research and Policy, University of California San Diego, La Jolla, California, USA .,Global Health Policy and Data Institute, San Diego, California, USA.,Global Health Program, Department of Anthropology, University of California San Diego, La Jolla, California, USA
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