Analyzing Twitter Chatter About Tobacco Use Within Intoxication-related Contexts of Alcohol Use: "Can Someone Tell Me Why Nicotine is So Fire When You're Drunk?"

INTRODUCTION: Alcohol and tobacco are commonly used together. Social influences within online social networking platforms contribute to youth and young adult substance use behaviors. This study used a sample of alcohol- and tobacco-related tweets to evaluate: (1) sentiment toward co-use of alcohol and tobacco, (2) increased susceptibility to tobacco use when consuming alcohol, and (3) the role of alcohol in contributing to a failed attempt to quit tobacco use. METHODS: Data were collected from the Twitter API from January 1, 2019 through December 31, 2019 using tobacco-related keywords (e.g., vape, ecig, smoking, juul*) and alcohol-related filters (e.g., drunk, blackout*). A total of 78,235 tweets were collected, from which a random subsample (n = 1,564) was drawn for coding. Cohen's Kappa values ranged from 0.66 to 0.99. RESULTS: Most tweets were pro co-use of alcohol and tobacco (75%). One of every ten tweets reported increased susceptibility to tobacco use when intoxicated. Non-regular tobacco users reported cravings for and tobacco use when consuming alcohol despite disliking tobacco use factors such as the taste, smell, and/or negative health effects. Regular tobacco users reported using markedly higher quantities of tobacco when intoxicated. Individuals discussed the role of alcohol undermining tobacco cessation attempts less often (2.0%), though some who had quit smoking for prolonged periods of time reported reinitiating tobacco use during acute intoxication episodes. CONCLUSIONS: Tobacco cessation interventions may benefit from including alcohol-focused components designed to educate participants about the association between increased susceptibility to tobacco use when consuming alcohol and the role of alcohol in undermining tobacco cessation attempts. IMPLICATIONS: Sentiment toward co-use of alcohol and tobacco on Twitter is largely positive. Individuals reported regret about using tobacco, or using more than intended, when intoxicated. Those who had quit smoking or vaping for prolonged periods of time reported reinitiating tobacco use when consuming alcohol. While social media-based tobacco cessation interventions like the Truth Initiative's "Ditch the Juul" campaign demonstrate potential to change tobacco use behaviors, these campaigns may benefit from including alcohol-focused components designed to educate participants about the association between increased susceptibility to tobacco use when consuming alcohol and the role of alcohol in undermining tobacco cessation attempts.

#Alcohol: Portrayals of Alcohol in Top Videos on TikTok.

OBJECTIVE: The purpose of this study was to characterize the content and themes present in user-generated TikTok videos portraying alcohol. METHOD: We captured the 100 most popular videos including the #alcohol hashtag on the popular social networking site TikTok. We used an iterative process to codebook development, resulting in codes for user sentiment toward alcohol, type of alcohol depicted, brand references, degree of alcohol use, and positive/negative associations with alcohol use. Videos were independently double coded, evaluated for inter-rater agreement, and adjudicated if differences were present. RESULTS: The videos in our sample were collectively viewed 291,999,100 times. The vast majority (98%) of videos expressed pro-alcohol sentiment. Nearly half of videos (41%) were guide videos demonstrating drink recipes. The majority of videos (72%) included liquor. Consuming multiple drinks quickly was depicted in more than half of videos (61%), whereas intoxication (13%) was exhibited less frequently. Positive associations with alcohol were prevalent; 69% of videos conveyed positive experiences with alcohol, 55% of videos contained humor, and 45% included associations of alcohol with camaraderie. Negative associations with alcohol were rarely portrayed (4%). CONCLUSIONS: Top alcohol-related videos on TikTok are heavily viewed. Their contents demonstrate a propensity to promote rapid consumption of multiple drinks and to juxtapose alcohol use with positive associations such as humor and camaraderie, while rarely depicting negative outcomes associated with hazardous alcohol use.