Content analysis of email marketing communications among online e-cigarette retailers.

INTRODUCTION: Online e-cigarette retailers use email communications to promote products directly to consumers, which may facilitate e-cigarette use. Little is known about the content of these emails. As such, this study collected emails from online e-cigarette retailers in California to conduct a content analysis. METHODS: This study included 13 online e-cigarette retailers in California using Yelp. To be included in the study, e-cigarette retailers needed a live website, physical retail location (i.e., vape shop), and e-cigarettes available for purchase online. The research team entered each website and signed up (if possible) for an email newsletter. Data were collected from the Gmail Application Programming Interface over a 1-year study period (11/01/21-11/01/22). Members of the research team coded emails for the presence of e-cigarettes, other products, flavors, marketing categories, and promotional activities, among other variables. RESULTS: 749 promotional emails (2.1 avg/per day) were received over the 1-year study period. Second-generation e-cigarettes (n=581, 77.6%) were the most observed product in emails followed by disposable e-cigarettes (n=391, 52.2%). The most common flavor profile was fruit/sweet/liquor (n=424, 56.6%). Emails included links to social media pages (n=366, 48.9%). Online coupons were found in 53.1% (n=398) of the emails. Age warnings were displayed in 8.0% (n=60) of the emails. CONCLUSIONS: E-cigarette retailers' emails promoted new products, flavors, and contained promotional discounts. Future research should examine the impact of exposure to such emails on e-cigarette-related attitudes and behaviors. IMPLICATIONS: Findings from this study may help inform prevention programs and interventions focused on increasing tobacco-related digital media literacy (i.e., evaluate tobacco advertising messages on digital media) among gender and ethnic minorities. Future research should examine if exposure to email marketing is causally linked with e-cigarette use among gender and ethnic minorities.

Effects of cannabis use on cigarette smoking cessation in LGBTQ+ individuals.

OBJECTIVE: Sexual and gender minority individuals are more likely to use tobacco and cannabis and have lower cigarette cessation. This study examined cannabis use associations with daily cigarettes smoked in sexual and gender minority individuals before and during a quit attempt. METHOD: Participants included dual smoking same-sex/gender couples from California that were willing to make a quit attempt (individual n = 205, 68.3% female sex). Participants reported baseline past 30-day cannabis use and number of cigarettes smoked and cannabis use (yes/no) during 35 nightly surveys. Individuals with current cannabis use reported baseline cannabis use and/or nightly survey cannabis use. Multilevel linear models predicted number of cigarettes smoked by cannabis use. RESULTS: Number of cigarettes decreased from before to during a quit attempt, but this decrease was smaller in individuals with current cannabis use compared to no current cannabis use (p < .001). In individuals with current cannabis use, number of cigarettes smoked was greater on days with cannabis use (p < .001). Furthermore, cannabis use that day increased overall number of cigarettes in those with relatively high overall cannabis use but only during a quit attempt in those with relatively low cannabis use (Within-Subject Cannabis Use × Between-Subject Cannabis Use × Quit Attempt interaction; p < .001). CONCLUSIONS: Sexual and gender minority individuals with cannabis and cigarette use may have a harder time quitting smoking than those who do not use cannabis. For those with cannabis use, guidance on not using cannabis during a quit attempt may improve cigarette cessation outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Surveillance of Gun-Related Conversations on Twitter.

Gun violence in the USA is a documented public health crisis. Publicly accessible data from Twitter posts can be used to rapidly capture and describe the public's recent conversations about guns. Because these gun-related conversations change rapidly, it is important to provide regularly updated information on them. Twitter posts containing gun-related terms were obtained from January 1, 2022 to June 30, 2022. To understand topics of gun-related tweets (N = 449,492), topic modeling was performed with Top2Vec. Gun ownership control, concern about gun safety and its impact on children and schools, and the Second Amendment were major areas of the gun-related discourse on Twitter. Several identified topics in this study were a consequence of the study period, including "Discourse on Capitol Riots," and "Wartime and Military Use of Guns," with the latter topic containing conversations about the Russia-Ukraine War. Conversations around the influence of the National Rifle Association (NRA) on gun policies and pro-gun ownership perspectives were also part of the public discourse. The intersection between alcohol, substance use, and gun use was infrequently observed. Findings suggest that gun-related conversations in social media such as Twitter can inform public health researchers.

Online Purchase Attempts of Flavored E-Cigarettes to Minors in California Before and After Senate Bill 793.

This survey study assesses whether the online purchase attempt completion rate of e-cigarettes changed after passage of California Senate Bill 793.

Spanish-language tobacco-related posts on Twitter: content analysis.

INTRODUCTION: Twitter data has been used to surveil public sentiment about tobacco products, however, most tobacco-related Twitter research has been conducted with English-language posts. There is a gap in the literature on tobacco-related discussions on Twitter in languages other than English. This study summarized tobacco-related discussions in Spanish on Twitter. METHODS: A set of Spanish terms reflecting electronic cigarettes (e.g., cigarillos electrónicos), cigarettes (e.g., "pitillo"), and cigars (e.g., "cigaro") were identified. A content analysis of tweets (n=1,352) drawn from 2021 was performed to examine themes and sentiment. An initial codebook was developed in English then translated to Spanish and then translated back to English by a bilingual (Spanish and English) member of the research team. Two bilingual members of the research team coded the tweets into themes and sentiment. RESULTS: Themes in the tweets included 1) product promotion (n=168, 12.4%), 2) health warnings (n=161, 11.9%), 3) tobacco use (n=136, 10.1%), 4) health benefits of vaping (n=58, 4.3%), 5) cannabis use (n=50, 3.7%), 6) cessation (n=47, 3.5%), 7) addiction (n=33, 2.4%), 8) policy (n=27, 2.0%), and 9) polysubstance use (n=12, 0.9%). Neutral (n=955, 70.6%) was the most common category of sentiment observed in the data. CONCLUSIONS: Tobacco products are discussed in multiple languages on Twitter and can be summarized by bilingual research teams. Future research should determine if Spanish-speaking individuals are frequently exposed to pro-tobacco content on social media and if such exposure increases susceptibility to use tobacco among never users or sustained use among current users. IMPLICATIONS: Spanish-language pro-tobacco content exists on Twitter, which has implications for Spanish-speaking individuals who may be exposed to this content. Spanish-language pro-tobacco-related posts may help normalize tobacco use among Spanish-speaking populations. As a result, anti-tobacco tweets in Spanish may be necessary to counter areas of the online environment that can be considered pro-tobacco.

Oral Nicotine Gum Discussions On Twitter: Content Analysis.

BACKGROUND: Oral nicotine gum such as LUCY, which come in colorful packaging, mimicking traditional chewing gum, are becoming popular. Many brands of gum have not been approved by the FDA for smoking cessation. This study examined public discourse about, including sentiment toward, oral nicotine gum on Twitter. METHODS: We used Twitter's Streaming Application Programming Interface to collect data from January 1, 2021, to December 21, 2021, using "nicotine gum" and/or "#nicotinegum" search terms (N=19,171 unique tweets were collected). We used an inductive approach to become familiar with the data, generated a codebook, and conducted a content analysis on (n=2,152) tweets. RESULTS: Cessation (n=716, 33.3%), personal experience (n=370, 17.2%), and addicted to gum (n=135, 6.3%) were the most prevalent themes. Cessation tweets primarily discussed cigarette smoking cessation (n=418, 58.4% of cessation tweets) and successful cessation experiences (n=155, 21.6%). Other identified themes pertained to using nicotine gum for cognitive enhancement or catching a "buzz" (n=102, 4.7%), marketing (n=98, 4.6%), using nicotine gum with other substances (n=90, 4.2%), and adverse effects (n=63, 2.9%). Sentiment analysis results revealed that 675 (44.2%) tweets were categorized as neutral, 605 (39.6%) tweets were classified as positive, and 248 tweets (16.2%) were negative. CONCLUSIONS: About one-third of tweets in our corpus mentioned nicotine gum in the context of smoking cessation. Most nicotine gum-related posts conveyed positive and neutral sentiments. Future studies should consider adding novel nicotine gum-specific search terms as well as exploring other social media platforms to gain more insights about these products. IMPLICATIONS: Our findings suggest that Twitter has the potential to track and facilitate conversations between those seeking cigarette cessation advice and those who have successfully quit tobacco by using nicotine gum. Monitoring of promotional content from nicotine gum companies are needed to ensure these products are not appealing to youth and non-users of tobacco.

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 (e.g., 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. 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.

Examining tobacco-related social media research in government policy documents: systematic review.

BACKGROUND: Social media data has been used to describe tobacco industry marketing practices, user experiences with tobacco, and youth-oriented pro-tobacco 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 (e.g., 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 pro-tobacco content online. Continued surveillance of social media may be necessary to track the changing tobacco landscape.

Monitoring website marketing among leading e-cigarette brands and vendors in California: content analysis.

BACKGROUND: Electronic cigarette (e-cigarette) brands and vendors use websites to promote pro-tobacco messages that may increase susceptibility to use e-cigarettes among never users or help sustain continued e-cigarette use among current users. E-cigarette website marketing is lightly regulated, and little is known about promotional strategies used on e-cigarette companies' websites. This study conducted a content analysis of website marketing from leading e-cigarette companies selling products in California. METHODS: This study identified 20 e-cigarette vendors and 6 e-cigarette brands that had products available for purchase online in California. Two coders visited 26 websites between 06 February 2022 and 17 April 2022. Websites were coded for marketing themes, promotional and interactive content, availability of flavoured e-cigarette products, presence of health warnings, and reference to tobacco control policies. RESULTS: Marketing themes related to physical health benefits of e-cigarette use were found on 50.0% of the websites. 57.7% of the websites had sales/discounts/coupons. 65.4% of the websites had fruit-flavoured disposable e-cigarettes, while 73.1% of the websites had fruit-flavoured e-liquids available for purchase. 69.2% of the websites allowed users to sign up for email newsletters, and 88.9% of such websites did not require users to create an age-verified account to receive email newsletters. CONCLUSIONS: Findings from this study can be used to inform statewide regulations of promotional communications found on e-cigarette companies' websites and encourage enforcement of age-verification procedures. This may help reduce susceptibility to use, or continued use of, e-cigarette products among price-sensitive populations, such as adolescents and young adults.

A thematic analysis of Puff Bar-related content on TikTok.

Background: Puff Bar has rapidly captured a large proportion of the disposable e-cigarette market. To stay abreast of the rapidly changing e-cigarette-product landscape, researchers have turned to social media platforms to monitor e-cigarette-related discussions and marketing trends. TikTok is the latest social media platform to capture the attention of adolescents and young adults; however, e-cigarette-related research using TikTok is limited. Objectives: This study examined Puff Bar-related posts on TikTok to identify themes and user engagement. Methods: Data were collected by scraping publicly available TikTok posts that contained the hashtag #puffplus, between January 31, 2020 and May 4, 2021 (n = 581). The research team used an inductive approach to identify 19 themes from the data. User engagement with posts including the number of likes, shares, plays, and comments was also collected. Results: The most prevalent themes included Music at 75.39% (438/581), followed by Flavors at 51.64% (300/581), Youth/Young Adults at 42.86% (249/581), Tobacco Use at 41.14% (239/581), Nicotine Concentration at 35.11% (204/581), Humor at 19.45% (113/581) and Product Review at 19.1% (111/581). Cessation 1.38% (8/581) and Health Warnings 2.58% (15/581) were two themes rarely observed but commonly engaged with by TikTok users. Conclusions: Health communication strategists should prepare to address TikTok's popularity to combat its contribution to the online e-cigarette environment. Future research should determine the impact of exposure to Puff Bar-related content on TikTok on adolescents' and young adults' attitudes and behaviors.

Cartoon marketing exposure decreases perceived risks of e-cigarette use in adolescents.

e-Cigarette companies use cartoon images to market their products, and exposure to this marketing strategy may lead to increased risk for adolescent e-cigarette use. This study examined the effects of cartoon marketing image exposure on perceived expectations of benefits and risks of e-cigarette use, and willingness to buy e-cigarette-related products in the future, among adolescents with and without a history of e-cigarette use. To accomplish this, participants completed an online survey experiment, during which they were randomly assigned to view pictures of e-cigarette products with cartoon or noncartoon packaging, followed by questionnaires about wanting to buy e-cigarettes, and perceived benefits and risks of e-cigarette use. Participants, a sample of Southern California high school students (ninth to 11th grade; N = 1,376), completed the study from September 2021 to November 2021. Overall, 27% of participants had used an e-cigarette or other tobacco product at least once in their lifetime (ever user). Thirty-six percent of participants never used e-cigarettes or other tobacco products but were considered to be susceptible to using e-cigarettes in the future (susceptible-never user). Thirty-seven percent of participants never used e-cigarettes or other tobacco products and were considered insusceptible to using e-cigarettes in the future (insusceptible-never user). There were no significant differences between image exposure groups (cartoon, no cartoon) on demographic variables (age, gender, race/ethnicity), lifetime e-cigarette use, or susceptibility to use in the future. Exposure to e-cigarette-related cartoon-based marketing produced lower perceived e-cigarette-related risks in insusceptible-never users. Exposure to e-cigarette marketing with cartoon images decreases the perceived harmfulness of e-cigarettes, which can increase adolescents' intentions to try e-cigarettes. Curbing adolescent e-cigarette use is a national public health priority. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Monitoring the Official YouTube Channels of E-Cigarette Companies: A Thematic Analysis.

BACKGROUND: E-cigarette companies use YouTube to foster brand awareness, market their products, and interact with current and future tobacco users. However, research on the official YouTube channels of e-cigarette companies is limited. This study determined the themes of, and degree of user engagement with, videos posted to the official channels of e-cigarette companies on YouTube. METHODS: Data were collected from the official YouTube channels of seven e-cigarette companies by scraping (i.e., electronically copying) the videos. The earliest video was posted on October 10, 2013, and the most recent video was posted on April 22, 2021 (n = 260). An inductive approach was used to identify themes in the data. User engagement with posts including number of likes, dislikes, and comments were also collected. RESULTS: Prevalent themes included branding (n = 250 of 260 videos, 96%), youth use (n = 222, 85%), and tobacco use (n = 210, 81%), while less common themes included misleading health statements (n = 4, 2%), personal choice (n = 4, 2%), and antitobacco (n = 2, 1%). Videos that contained the themes testimonial, product design features, and instructional received the highest mean number of likes. Videos that contained the themes antitobacco, cessation, and testimonial received the highest mean number of dislikes. The 260 videos in this study were collectively viewed 6,619,700 times as of May 5, 2021. CONCLUSIONS: Videos from the official YouTube channels of seven e-cigarette companies often focused on branding and user experience but rarely mentioned cessation. While videos about cessation were rare, they received the second highest mean number of dislikes. Future research should assess the impact of exposure to e-cigarette-related content on YouTube and e-cigarette-related attitudes and behaviors.

The Need for Tobacco-Related Interventions to Incorporate Digital Media Literacy.

This Viewpoint discusses the need for health promotion programs and interventions to bolster tobacco-related digital media literacy among adolescents, young adults, parents, teachers, and public health organizations.

An Analysis of Twitter Posts About the U.S. Food and Drug Administration's Menthol Ban.

INTRODUCTION: Although the U.S. Food and Drug Administration (FDA) banned characterizing flavors in cigarettes in 2009, this initial ban exempted menthol. After examining numerous reports on the adverse health effects of menthol cigarettes, the FDA proposed a menthol ban in April 2022. This study analyzed Twitter data to describe public reaction to this announcement. AIMS AND METHODS: Posts containing the word "menthol" and/or "#menthol" were collected from April 21, 2022 to May 5, 2022 from Twitter's Streaming Application Programming Interface (API). A random sampling procedure supplied 1041 tweets for analysis. Following an inductive approach to content analysis, posts were classified into one or more of 11 themes. RESULTS: Posts discussed the FDA announcement (n = 153, 14.7%), racial discrimination (n = 101, 9.7%), distrust in government (n = 67, 6.4%), inconsistencies between policies (n = 52, 5.0%), public health benefits (n = 42, 4%), freedom of choice (n = 22, 2.1%), and health equity (n = 21, 2.0%). Posts contained misinformation (n = 20, 1.9%), and discussed the potential for illicit markets (n = 18, 1.7%) and the need for cessation support (n = 4, 0.4%). 541 (52.0%) tweets did not fit into any of the prescribed themes. CONCLUSIONS: Twitter posts with the word "menthol" commonly discussed distrust in government and mentioned racial discrimination. Findings demonstrated the possibility of near real-time Twitter monitoring of public opinion on a menthol ban. These data may be valuable for designing tobacco control health communication campaigns in the future. IMPLICATIONS: The U.S. FDA proposed a ban on menthol cigarettes in April 2022. This study's content analyzed Twitter posts over a 2-week period to understand the public's response to the proposed menthol ban. Twitter posts with the word "menthol" often discussed distrust in government and mentioned racial discrimination. Findings demonstrated the possibility of near real-time Twitter monitoring of public opinion of regulatory action. Findings underscore the need to educate the public about the potential health benefits of banning menthol from cigarettes, particularly for populations that experience tobacco-related health disparities.

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.

Ice Flavor-Related Discussions on Twitter: Content Analysis.

BACKGROUND: The US Food and Drug Administration (FDA) recently restricted characterizing flavors in tobacco products. As a result, ice hybrid-flavored e-cigarettes, which combine a cooling flavor with fruit or other flavors (eg, banana ice), emerged on the market. Like menthol, ice-flavored e-cigarettes produce a cooling sensory experience. It is unclear if ice hybrid-flavored e-cigarettes should be considered characterizing flavors or menthol, limiting regulatory action. Monitoring the public's conversations about ice-flavored e-cigarettes on Twitter may help inform the tobacco control community about these products and contribute to the US FDA policy targets in the future. OBJECTIVE: This study documented the themes pertaining to vaping and ice flavor-related conversations on Twitter. Our goal was to identify key conversation trends and ascertain users' recent experiences with ice-flavored e-cigarette products. METHODS: Posts containing vaping-related (eg, "vape," "ecig," "e-juice," or "e-cigarette") and ice-related (ie, "Ice," "Cool," "Frost," and "Arctic") terms were collected from Twitter's streaming application programming interface from January 1 to July 21, 2021. After removing retweets, a random sample of posts (N=2001) was selected, with 590 posts included in the content analysis. Themes were developed through an inductive approach. Theme co-occurrence was also examined. RESULTS: Many of the 590 posts were marked as (or consisted of) marketing material (n=306, 51.9%), contained positive personal testimonials (n=180, 30.5%), and mentioned disposable pods (n=117, 19.8%). Other themes had relatively low prevalence in the sample: neutral personal testimonials (n=45, 7.6%), cannabidiol products (n=41, 7%), negative personal testimonials (n=41, 7%), "official" flavor description (n=37, 6.3%), ice-flavored JUUL (n=19, 3.2%), information seeking (n=14, 2.4%), and comparison to combustible tobacco (n=10, 1.7%). The most common co-occurring themes in a single tweet were related to marketing and disposable pods (n=73, 12.4%). CONCLUSIONS: Our findings offer insight into the public's experience with and understanding of ice-flavored e-cigarette products. Ice-flavored e-cigarette products are actively marketed on Twitter, and the messages about them are positive. Public health education campaigns on the harms of flavored e-cigarettes may help to reduce positive social norms about ice-flavored products. Future studies should evaluate the relationship between exposure to personal testimonials of ice-flavored vaping products and curiosity, harm perceptions, and experimentation with these products among priority populations.

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

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

Association Between Exposure to Tobacco Content on Social Media and Tobacco Use: A Systematic Review and Meta-analysis.

Importance: Exposure to tobacco-related content on social media may foster positive attitudes toward tobacco products and brands, and influence the likelihood of initiating or continuing use of tobacco, especially among adolescents and young adults. Objective: To perform the first systematic review and meta-analysis, to our knowledge, on studies that examined the association between exposure to tobacco content on social media and lifetime tobacco use, past 30-day tobacco use, and susceptibility to use tobacco among never users. Data Sources: Tobacco, social media, and marketing search terms were entered into online databases, including MEDLINE, ISI Web of Science, Scopus, and PsychINFO. Study characteristics, including research design and methods, sampling strategy, and demographics, were assessed for each study. Study Selection: Studies reporting odds ratios (ORs) for self-reported exposure to, or experimentally manipulated, tobacco content on social media and lifetime tobacco use, past 30-day tobacco, and susceptibility to use tobacco among never users. The systematic search produced 897 independent articles, of which 29 studies met inclusion criteria. Data Extraction and Synthesis: A 3-level random-effects meta-analysis was used to estimate ORs, 95% CIs, and heterogeneity (I2) for each tobacco use outcome. Study quality and publication bias were assessed. Main Outcomes and Measures: Lifetime tobacco use, past 30-day tobacco use, and susceptibility to use tobacco among never users. Tobacco use included e-cigarettes, cigarettes, and other (cigar, hookah, smokeless tobacco). Results: The total sample size across the 24 included datasets was 139 624, including 100 666 adolescents (72%), 20 710 young adults (15%), and 18 248 adults (13%). Participants who were exposed to tobacco content on social media, compared with those who were not exposed, had greater odds of reporting lifetime tobacco use (OR, 2.18; 95% CI, 1.54-3.08; I2 = 94%), past 30-day tobacco use (OR, 2.19; 95% CI, 1.79-2.67; I2 = 84%), and susceptibility to use tobacco among never users (OR, 2.08; 95% CI, 1.65-2.63; I2 = 73%). Subgroup analyses showed similar associations for tobacco promotions, active engagement, passive engagement, lifetime exposure to tobacco content, exposure to tobacco content on more than 2 platforms, and exposure to tobacco content among adolescents and young adults. Conclusions and Relevance: Findings suggest that a comprehensive strategy to reduce the amount of tobacco content on social media should be developed by federal regulators. Such actions may have downstream effects on adolescent and young adult exposure to protobacco content, and ultimately tobacco use behaviors.

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

Introduction: Research is needed to understand the frequency of e-cigarette impressions in scripted television and movies, especially in scripted content with characters and storylines that may appeal to young adults. This study aimed to determine the extent of e-cigarette-related imagery and dialogue in Netflix content popular with young adults. We also determine the demographics and character qualities of actors shown holding e-cigarettes. Methods: Nielsen ratings data were used to compile a list of the most popular Netflix original films and TV shows among U.S. viewers 18-24 years old between June 1, 2020, and May 31, 2021. We used a sample of 12 films and 113 TV episodes from 12 series. Three coders were trained to analyze a total of 101 h of content for the presence of e-cigarettes, level of use, type of characters holding e-cigarettes, brand visibility, and the presence of vaping-related dialogue. Twenty percent of all episodes/films were double coded to ensure reliability. Results: Out of 125 titles, 16 (13%) had e-cigarette-related content. Thirteen titles (10%) showed at least one character holding an e-cigarette, and three others mentioned vaping without showing e-cigarettes. The total time of e-cigarettes onscreen amounted to 399 s and the average screen time for e-cigarettes was 31 s. Ninety-nine percent of the time an e-cigarette appeared on screen it was being held by a character. Conclusion: This study documented recent e-cigarette imagery found on Netflix and demonstrates the need for health communication campaigns to denormalize e-cigarette use, particularly among susceptible populations, such as young adults.