Examining the Peer-Reviewed Literature on Tobacco-Related Social Media Data: Scoping Review.

INTRODUCTION: Tobacco researchers have used social media data to examine tobacco industry marketing practices (eg, influencers), and to document user experience with tobacco products. This study summarized the literature that analyzed tobacco-related social media data, including domain, social media platform, tobacco product type, and themes of findings, among other variables. AIMS AND METHODS: PubMed, PsycINFO, Web of Science, and Communication Source were searched between 2004 and 2022. Peer-reviewed articles were included if they were written in English, included at least one tobacco-related term, and one social media-related term, and analyzed a social media post. Two coders screened all-titles and abstracts. The final sample consisted of (n = 255) articles. Studies were coded for domain, social media platform, tobacco product type, data source, type of data, coding and analytic method, and presence of validation procedure, among other variables. RESULTS: A total of 10 504 820 581 tobacco-related social media posts were assessed across 255 studies. User experience (54.1%) and promotion (23.1%) were the most researched domains. Researchers used data from Twitter the most (42.7%). Text (43.1%) was the most common type of data analyzed. Thematic analysis (80.8%) was the most common analytic technique. Themes of findings from content analyses often pertained to the health effects of tobacco use (61.0%) and promotion (44.2%). CONCLUSIONS: Researchers have analyzed billions of tobacco-related social media posts to describe user experience with, and promotions related to, tobacco products like e-cigarettes on platforms like Twitter. Future research may examine tobacco-related social media data from newer platforms like TikTok. IMPLICATIONS: Real-time surveillance of tobacco-related content on social media can keep the tobacco control community abreast of tobacco industry promotional strategies, user experience with tobacco products, and perceived health effects of tobacco use. A framework may be developed to establish best-practices for social media data collection and analysis, including strategies to identify posts from bot accounts and validate methodological approaches used in thematic analysis.

E-cigarette Marketing Expenditures in the United States From 2016 to 2021: Targeted Media Outlets Geared Toward People Who Are at Increased Risk for Tobacco Use.

INTRODUCTION: E-cigarette advertising exposure is linked to e-cigarette initiation and use. Thus, monitoring trends in e-cigarette advertising practices is important to understand e-cigarette use patterns observed over recent years. AIMS AND METHODS: E-cigarette advertising expenditures (January 2016-July 2021; Numerator Ad Intel) for 154 U.S. market areas were harmonized with U.S. Census sociodemographic data through Nielsen zip code designations by market area. Descriptive statistics and multivariable linear regressions were used to examine trends in e-cigarette advertising expenditures across media outlets and associations between sociodemographic characteristics and e-cigarette advertising over time. RESULTS: E-cigarette advertising expenditures peaked in 2018/2019, followed by a sharp decline in 2020. Expenditures were concentrated primarily on print (58.9%), TV (20.6%), and radio (14.4%). Major print outlets were Sports Illustrated, Rolling Stone, and Star magazines. Top TV channels were AMC, Investigation Discovery, and TBS. TV advertisements were purchased commonly during popular movies and TV series (eg King of Queens, Everybody Loves Raymond, The Walking Dead). Higher expenditures were associated with U.S. market areas that had (1) a larger percentage of non-rural zip codes (radio), (2) smaller male populations (radio), and (3) larger White or Caucasian, Black or African American, American Indian or Alaska Native, Asian, and Other or Multiracial populations (radio, print, online display, and online video). CONCLUSIONS: E-cigarette companies advertised in print magazines geared toward males and youth and young adults, radio commercials focused in urban areas with smaller male populations, and nationwide TV commercials. Declines in e-cigarette advertising expenditures in 2020 demonstrate the potential impact that federal policies may have on protecting populations who are at higher risk for tobacco use from predatory advertising practices. IMPLICATIONS: E-cigarette advertising exposure is associated with the initiation and use of e-cigarettes. This study shows how e-cigarette marketing expenditures in the United States may have targeted specific consumers (eg youth and young adults) between 2016 and 2021. The precipitous drop in advertising expenditures across all outlets during early 2020 corresponds with the implementation of the Tobacco 21 federal policy, the federal enforcement policy to remove most unauthorized flavored e-cigarette cartridges from the U.S. market, preparations for FDA's premarket review of e-cigarette products, and the decision by several TV broadcast companies to stop showing e-cigarette ads. The potential impact of federal policies may have far-reaching implications for protecting populations who are at high risk for tobacco use and its health consequences.

Trends in public interest in shopping and point-of-sales of JUUL and Puff Bar 2019-2021.

INTRODUCTION: We investigated public interest in shopping and point-of-sales (POS) of JUUL and Puff Bar products in the context of five regulatory, company sales policy and other events of interest that may have influenced the trajectory of these products during 2019-2021. METHODS: Outcome variables included relative search volume (RSV) from Google search queries indicative of shopping interest in and aggregate dollar sales from Nielsen POS for JUUL and Puff Bar in the USA from March 2019 to May 2021. Adjusted autoregressive integrated moving average assessed the observed and predicted trends and adjusted linear regression analysis measured the relative rate of change in the outcome variables for each time period of interest. RESULTS: After the Trump administration announced its plans to ban flavoured e-cigarettes and JUUL Labs, Inc.'s decided to suspend the sales of its sweet and fruity flavoured products, JUUL's shopping interest RSV and sales declined while Puff Bar's shopping interest RSV peaked, and its sales increased. From the period following FDA's announcement of its enforcement guidance policy on unauthorised flavoured cartridge-based e-cigarettes until May 2021, JUUL's shopping interest RSV and sales continued to decline. Puff Bar's shopping interest RSV increased, and its sales peaked until the House approved the flavoured e-cigarette ban bill. Puff Bar's sales steeply declined following suspension of its sales in February 2020. The decline, however, slowed after Puff Bar products were relaunched as 'synthetic nicotine' e-cigarettes. CONCLUSIONS: Puff Bar's unprecedented peak in the shopping interest and sales of Puff Bar warrants continued surveillance.

Describing Memes Referencing Vaping: Thematic Analysis.

Background: Memes, images or videos with text overlay that embody a concept or belief about the contemporary society, are endemic to Internet culture, are popular among youth and diffuse rapidly across social media platforms. E-cigarettes and vaping have grown in popularity in the era of Internet culture however there is little research describing the intersection of memes and vaping. This is an important gap in the literature as memes may be part of the broader online e-cigarette information landscape that can normalize vaping among young people. Memes could also point to emerging trends in product preferences. This study content analyzed memes to identify key themes, characters and vape products depicted therein. Methods: Data were drawn from a sub-reddit devoted to vaping-related memes. Memes were electronically copied from the forum to analyze (n = 527). Using an inductive approach, the research team identified 14 themes. Results: In-group communication (n = 202, 38.33%) was the most predominant theme followed by Critique of vaping regulations and public perceptions (n = 76, 14.42%), and Vape device modifications and hacks (n = 62, 11.76%). Memes included Cartoons (n = 124, 23.53%), Celebrities (n = 75, 14.23%), and Fictional characters (n = 53, 10.06%). Memes referenced Tanks or mods (n = 120, 22.77%), Component parts (n = 96, 18.22%) and E-liquids/Nicotine salts (n = 81, 15.37%). Conclusion: Memes referenced in-group communication and cartoons among other youth friendly images, raising concern about the potential to normalize vaping-related behaviors. Future research should monitor emerging vape devices and determine the impact of memes on attitudes and behaviors among adolescents and young adults. Implications: Given the popularity and reach of memes among youth, continuous monitoring of vaping-related memes may reveal aspects that may be addressed in vaping prevention campaigns.

Twitter Surveillance at the Intersection of the Triangulum.

INTRODUCTION: A holistic public health surveillance approach can help capture the public's tobacco and marijuana-related attitudes and behaviors. Using publicly available data from Twitter, this is one of the first studies to describe key topics of discussions related to each intersection (e-cigarette, combustible tobacco, and marijuana) of the Triangulum framework. AIMS AND METHODS: Twitter posts (n = 999 447) containing marijuana, e-cigarette, and combustible tobacco terms were collected from January 1, 2018 to December 23, 2019. Posts to Twitter with co-occurring mentions of keywords associated with the Triangulum were defined as an intersection (e-cigarettes and combustible tobacco, combustible tobacco and marijuana, e-cigarettes and marijuana, and marijuana, e-cigarettes and combustible tobacco). Text classifiers and unsupervised machine learning were used to identify predominant topics in posts. RESULTS: Product Features and Cartridges were commonly referenced at the intersection of e-cigarette and marijuana-related conversations. Blunts and Cigars and Drugs and Alcohol were commonly referenced at the intersection of combustible tobacco and marijuana-related discussions. Flavors and Health Risks were discussed at the intersection of e-cigarette and combustible-related conversations, while discussions about Illicit products and Health risks were key topics of discussion when e-cigarettes, combustible tobacco, and marijuana were referenced all together in a single post. CONCLUSION: By examining intersections of marijuana and tobacco products, this study offers inputs for designing comprehensive FDA regulations including regulating product features associated with appeal, improving enforcement to curb sales of illicit products, and informing the FDA's product review and standards procedures for tobacco products that can be used with marijuana. IMPLICATIONS: This study is the first to leverage the Triangulum framework and Twitter data to describe key topics of discussions at the intersection of e-cigarette, combustible tobacco, and marijuana. Real-time health communication interventions can identify Twitter users posting in the context of e-cigarettes, combustible tobacco, and marijuana by automated methods and deliver tailored messages. This study also demonstrates the utility of Twitter data for surveillance of complex and evolving health behaviors.

Tobacco promotion restriction policies on social media.

Tobacco promotion is prolific on social media, with each platform setting their own restrictions on tobacco promotion and sales. We evaluated the policies related to tobacco product promotion and sales on 11 sites that are popular with youth in May 2021: Discord, Facebook, Instagram, Pinterest, Reddit, Snapchat, TikTok, Tumblr, Twitch, Twitter and YouTube. Nine of the 11 sites prohibited paid advertising for tobacco products. However, only three of them clearly prohibited sponsored content (ie, social influencers) that promotes tobacco. Six platforms restricted content that sells tobacco products and three tried to prohibit underage access to content that promotes or sells tobacco products. Although most platform policies prohibited paid tobacco advertising, few addressed more novel strategies, such as sponsored/influencer content and few had age-gating to prevent youth access. There is a pressing need to regulate tobacco promotion on social media platforms.

For or Against Tobacco Control: Sponsored Tobacco Advocacy Messages on Facebook and Instagram.

INTRODUCTION: This study explores sponsored tobacco advocacy messages on Facebook and Instagram by: (1) Examining differences in message performance metrics, funding sources, and audience characteristics of anti- and protobacco messages in the United States, and (2) Characterizing audience exposure to anti- and protobacco message themes across different age-groups and by gender. METHODS: The analysis sample consisting of 375 tobacco-advocacy related messages on Instagram and/or Facebook in the United States from May 29, 2020 to July 26, 2020 was obtained from the Facebook Ad Library Application Programming Interface. Chi-square tests compared differences in anti- and protobacco messages by potential reach, impressions, approximate spend ($), social media platform type, average duration of delivery, type of funding sources, and audience age and gender exposure. Percentage distribution of message themes and audience exposure by age and gender were also examined. RESULTS: Antitobacco messages (n = 334, 89.07%) exceeded protobacco messages (n = 41, 10.93%) overall. Antitobacco messages had lower potential reach, received a lower proportion of impressions, and spent a lower proportion of money per message. Protobacco advocacy was funded primarily by the tobacco industry and advocacy groups. A small fraction of antitobacco advocacy messages reached young adults and men. Among protobacco advocacy messages, a majority of messages highlighting tobacco regulations, addiction, citizen advocacy, flavors, and impact on economy reached mostly men. CONCLUSION: Results illustrate important gaps in current sponsored antitobacco advocacy efforts, demonstrate the feasibility of monitoring sponsored tobacco advocacy on these platforms, and offer insights for future antitobacco advocacy campaigns. IMPLICATIONS: Future antitobacco advocacy efforts on social media may consider more focused efforts in reaching young adults and men and in leveraging strategic social media analytics to improve their overall potential reach and impressions.

#FlavorsSaveLives: An Analysis of Twitter Posts Opposing Flavored E-cigarette Bans.

BACKGROUND: Starting in 2019 policies restricting the availability of flavored e-cigarette products were proposed or implemented in the United States to curb vaping by youth. People took to Twitter to voice their opposition, referencing the phrase "Flavors Save Lives." This study documented the emerging themes pertaining to "Flavors Saves Lives" over a 12-month period. METHODS: The study period was from May 1, 2019, to May 1, 2020. A stratified sampling procedure supplied 2500 tweets for analysis. Posts were classified by one or more of the following themes: (1) Political Referendum; (2) Institutional Distrust; (3) Individual Rights; (4) Misinformation; (5) THC Vaping is the Real Problem; (6) Smoking Cessation; (7) Adult Use; and (8) Not a Bot. The temporal pattern of tweets over the year was examined. RESULTS: Political Referendum (76.5%) and Institutional Distrust (31.3%) were the most prominent themes, followed by Not a Bot (11.0%), Individual Rights (10.4%), Adult Use (8.0%), Smoking Cessation (6.6%), Misinformation (5.9%), and THC Vaping is the Real Problem (3.5%). Total tweet frequencies increased in September 2019 and peaked in November 2019 before returning to relatively low numbers. Political Referendum and Institutional Distrust were consistently the most prevalent themes over time. CONCLUSION: Twitter posts with the phrase "Flavors Save Lives" commonly discussed voting against political incumbents and mentioned distrust of government representatives. Findings demonstrated the possibility of near real-time Twitter monitoring of public opposition to flavor bans. These data may be valuable for designing tobacco control information campaigns in the future. IMPLICATIONS: (a) Starting in 2019 policies restricting the availability of flavored e-cigarette products were proposed or implemented in the United States to curb vaping by youth. (b) This study content analyzed Twitter posts with the phrase "Flavors Save Lives" from a 12-month period to understand opposition to flavor restrictions. (c) Twitter posts commonly discussed voting against political incumbents and mentioned distrust of government representatives. (d) Findings demonstrated the possibility of near real-time Twitter monitoring of public opposition to flavor bans, and contribute to a more comprehensive assessment of different sub-population's responses to current and proposed tobacco control information policies.

Leading Topics in Twitter Discourse on JUUL and Puff Bar Products: Content Analysis.

BACKGROUND: In response to the recent government restrictions, flavored JUUL products, which are rechargeable closed-system electronic cigarettes (e-cigarettes), are no longer available for sale. However, disposable closed-system products such as the flavored Puff Bar e-cigarette continues to be available. If e-cigarette consumers simply switch between products during the current government restrictions limited to 1 type of product over another, then such restrictions would be less effective. A step forward in this line of research is to understand how the public discusses these products by examining discourse referencing both Puff Bar and JUUL in the same conversation. Twitter data provide ample opportunity to capture such early trends that could be used to help public health researchers stay abreast of the rapidly changing e-cigarette marketplace. OBJECTIVE: The goal of this study was to examine public discourse referencing both Puff Bar and JUUL products in the same conversation on Twitter. METHODS: We collected data from Twitter's streaming application programming interface between July 16, 2019, and August 29, 2020, which included both "Puff Bar" and "JUUL" (n=2632). We then used an inductive approach to become familiar with the data and generate a codebook to identify common themes. Saturation was determined to be reached with 10 themes. RESULTS: Posts often mentioned flavors, dual use, design features, youth use, health risks, switching 1 product for the other, price, confusion over the differences between products, longevity of the products, and nicotine concentration. CONCLUSIONS: On examining the public's conversations about Puff Bar and JUUL products on Twitter, having described themes in posts, this study aimed to help the tobacco control community stay informed about 2 popular e-cigarette products with different device features, which can be potentially substituted for one another. Future health communication campaigns may consider targeting the health consequences of using multiple e-cigarette products or dual use to reduce exposure to high levels of nicotine among younger populations.

Topics of Nicotine-Related Discussions on Twitter: Infoveillance Study.

BACKGROUND: Cultural trends in the United States, the nicotine consumer marketplace, and tobacco policies are changing. OBJECTIVE: The goal of this study was to identify and describe nicotine-related topics of conversation authored by the public and social bots on Twitter, including any misinformation or misconceptions that health education campaigns could potentially correct. METHODS: Twitter posts containing the term "nicotine" were obtained from September 30, 2018 to October 1, 2019. Methods were used to distinguish between posts from social bots and nonbots. Text classifiers were used to identify topics in posts (n=300,360). RESULTS: Prevalent topics of posts included vaping, smoking, addiction, withdrawal, nicotine health risks, and quit nicotine, with mentions of going "cold turkey" and needing help in quitting. Cessation was a common topic, with mentions of quitting and stopping smoking. Social bots discussed unsubstantiated health claims including how hypnotherapy, acupuncture, magnets worn on the ears, and time spent in the sauna can help in smoking cessation. CONCLUSIONS: Health education efforts are needed to correct unsubstantiated health claims on Twitter and ultimately direct individuals who want to quit smoking to evidence-based cessation strategies. Future interventions could be designed to follow these topics of discussions on Twitter and engage with members of the public about evidence-based cessation methods in near real time when people are contemplating cessation.

Characterising KandyPens-related posts to Instagram: implications for nicotine and cannabis use.

BACKGROUND: This study analysed posts to Instagram related to KandyPens, an open-system pod mod e-cigarette company, marketing its products as aromatherapy devices. The objective was to determine themes, corresponding user profiles and references to types of e-liquid solutions used with KandyPens. METHODS: Data consisted of publicly available posts to Instagram with the hashtag '#kandypens' collected from 8 June to 8 August 2018 (n=1775). Identified themes included: product appearance (eg, highlighting design features including colour of device), user experience (eg, vape tricks), flavours (eg, strawberry) and promotions (eg, $10 off). The type of e-liquid solutions (nicotine, aromatherapy and cannabis) used with KandyPens were also recorded. Instagram profiles were categorised into: vaping enthusiast/advocates, influencers, KandyPens' official Instagram account, vape vendors and average Instagram users. RESULTS: User experience (28.90%) and product appearance (21.80%) were predominant themes followed by promotions (10.08%), and flavours (1.01%). About 32.43 % of posts referenced cannabis-related solutions, 2.98 % of the posts mentioned nicotine-related solutions and 0.11 % of the posts mentioned aromatherapy. Average Instagram users (24.89%) posted the majority of posts followed by vape vendors (20.72%), KandyPens' official account (17.96%), vaping enthusiasts/advocates (10.75%) and influencers (0.45%). CONCLUSION: KandyPens markets its products as aromatherapy devices; however, Instagram posts related to these products rarely mentioned their purported purpose. Future research should consider product design, user experience and the co-use of nicotine and cannabis with KandyPens to assess implications related to product appeal and abuse liability.

In Lieu of Smoking: Are Smokers More Likely to Enact Certain Types of Implementation Intention Plans During a JIT Smoking Cessation?

BACKGROUND: To identify actionable and effective implementation intention (II) plans, we examined whether (a) IIs suggesting food or nicotine-based substitution strategies to help quit smoking cigarettes would be more likely to be enacted in real time, (b) IIs reminding participants to cognitively motivate themselves or engage in solitary activity would be more likely to be enacted than those suggesting seeking social support, and (c) II plan enactment based on the above strategies would be associated with reporting momentary lapse avoidance. METHOD: A sample of 57 Asian American young adult (18-25 years) smokers participated in a 4-week, mobile-based smoking cessation intervention, implemented in a Just-In-Time framework. User-specified IIs were categorized into nature of activity (cognitively motivate themselves, engage in solitary activity, seek social support) and type of substitution strategy (food, nicotine, no substitution). Outcome variable was momentary enactment of the given II. Generalized mixed linear models were used for analyses. RESULTS: IIs reminding participants to cognitively motivate themselves and/or engage in solitary activities were more likely to be enacted than IIs recommending seeking social support. IIs recommending nicotine-based substitution were more likely to be enacted than IIs that did not specify any substitution. IIs suggesting food-based substitution, however, were less likely to be enacted than those not suggesting a specific substitution. II plan enactment based on the above strategies was significantly associated with avoiding momentary lapses compared to when momentary lapses occurred. CONCLUSION: Specifying II recommendations found to be helpful with avoiding lapses in a smoking cessation context, can increase chances of II enactment, and improve overall health intervention outcomes.

Anhedonia, screen time, and substance use in early adolescents: A longitudinal mediation analysis.

INTRODUCTION: Screen time is associated with substance use risk among adolescents; however, less is known about the underlying factors that explain this association. METHODS: This research examined anhedonia, a facet of depression noted by the reduced capacity to experience pleasure, as a mediating factor in the relationship between screen time (hours spent watching television, using internet, and/or playing video games outside of school) and substance use (alcohol and/or cigarettes). We used a longitudinal survey design among a sample of students aged 9-11 years in the 4th to 6th grades in Southern California, United States of America [N = 709 (354 males)]. RESULTS: Structural equation modeling (SEM) findings revealed longitudinal mediation effects of anhedonia on the association between screen time and substance use, while controlling for baseline screen time, baseline individual and peer substance use, race/ethnicity, and gender. Moderation analysis based on a multiple-group approach revealed that gender was not a significant moderator of this mediation pathway. CONCLUSIONS: Adolescents may become desensitized and exhibit a blunted response to hedonic effects from increased screen time. This may result in increased anhedonia and greater risk for substance use through the need to compensate for the reduced experience of rewards. These findings have implications for future school-based substance use prevention and intervention programs.

Examining the vulnerability of ambivalent young adults to e-cigarette messages.

This study used a randomized online experiment to understand the interrelationships between e-cigarette benefit and harm perceptions, e-cigarette use ambivalence, and e-cigarette message exposure and perceived effectiveness. A high prevalence of ambivalent attitudes toward e-cigarettes at baseline was reported. Ambivalent individuals reported significantly higher benefits and lower harm perceptions compared to univalent individuals. Contrary to past findings, ambivalence was not responsive to persuasive messages in this study. This study situates e-cigarette use perceptions in a realistic setting. High baseline ambivalence in this study calls for more unequivocal messages from the FDA about the risks of e-cigarette use.

Tobacco Use Behaviors, Attitudes, and Demographic Characteristics of Tobacco Opinion Leaders and Their Followers: Twitter Analysis.

BACKGROUND: Tobacco-related content on social media is generated and propagated by opinion leaders on the Web who disseminate messages to others in their network, including followers, who then continue to spread the information. Opinion leaders can exert powerful influences on their followers' knowledge, attitudes, and behaviors; yet, little is known about the demographic characteristics and tobacco use behavior of tobacco opinion leaders on the Web and their followers, compared with general Twitter users. OBJECTIVE: In this study, we hypothesized that opinion leaders use more tobacco products and have higher nicotine dependence than the other 2 groups (eg, followers and general Twitter users) and that followers-those who spread messages by opinion leaders-would more likely be in demographic groups that are vulnerable to tobacco marketing influence (eg, young adults and lower educational attainment). METHODS: We constructed the social networks of people who tweet about tobacco and categorized them using a combination of social network and Twitter metrics. To understand the characteristics of tobacco opinion leaders and their followers, we conducted a survey of tobacco opinion leaders, their followers, and general Twitter users. The sample included 347 opinion leaders, 567 followers, and 519 general users. The opinion leaders had a median of 1000 followers, whereas followers and general users had fewer than 600 followers. RESULTS: Opinion leaders were more likely than their followers to report past month use of tobacco products; followers, in turn, were more likely to report past month use of these products than general Twitter users. The followers appeared to be an especially vulnerable group; they tended to be younger (mean age 22.4 years) and have lower education compared with the opinion leaders and general users. CONCLUSIONS: Followers of Twitter tobacco opinion leaders are a vulnerable group that might benefit from antitobacco education to counter the protobacco communications they see on social media.

Talking about tobacco on Twitter is associated with tobacco product use.

Tobacco-related content appears on social media in the form of advertising and messages by individuals. However, little is known about associations between posting social media messages and tobacco product use among adolescents and young adults. Self-reports of tobacco product use were obtained from the Children's Health Study of young adults in Southern California. Among the 1486 respondents in the most recent wave of the cohort (2016-2017), 284 provided tobacco product use data and their Twitter user names to access publicly available Twitter account data (mean age = 20.1 yrs. (SD = 0.6), 54% female, 49% Hispanic). We obtained the tweets that those respondents posted on Twitter, searched the tweets for 14 nicotine- and tobacco-related keywords, and coded these statements as positive or negative/neutral. Logistic regression analyses were conducted to determine whether respondents who posted positive tobacco-related tweets were more likely to report tobacco product use, relative to those who did not post any positive tobacco-related tweets. Respondents who posted any positive messages about tobacco had significantly higher odds of reporting past month use of cigarettes (OR = 3.15, 95% CI = 1.36, 7.30) and any tobacco product (OR = 2.41, 95% CI = 1.16, 5.01), relative to respondents who did not post about tobacco. This is the first study to establish an empirical link between adolescents' and young adults' tobacco-related Twitter activity and their tobacco product use. Health communications about the risks of tobacco use could target adolescents who post positive messages about tobacco products on Twitter.