Using Exogenous Social Media Exposure Measures to Assess the Effects of Smokeless Tobacco-Related Social Media Content on Smokeless Tobacco Sales in the United States.

INTRODUCTION: Prior research on the effects of social media promotion of tobacco products has predominantly relied on survey-based self-report measures of marketing exposure, which potentially introduce endogeneity, recall, and selection biases. New approaches can enhance measurement and help better understand the effects of exposure to tobacco-related messages in a dynamic social media marketing environment. We used geolocation-specific tweet rate as an exogenous indicator of exposure to smokeless tobacco (ST)-related content and employed this measure to examine the influence of social media marketing on ST sales. AIMS AND METHODS: Autoregressive error models were used to analyze the association between the ST-relevant tweet rate (aggregated by 4-week period from February 12, 2017 to June 26, 2021 and scaled by population density) and logarithmic ST unit sales across time by product type (newer, snus, conventional) in the United States, accounting for autocorrelated errors. Interrupted time series approach was used to control for policy change effects. RESULTS: ST product category-related tweet rates were associated with ST unit sales of newer and conventional products, controlling for price, relevant policy events, and the coronavirus disease 2019 (COVID-19) pandemic. On average, 100-unit increase in the number of newer ST-related tweets was associated with 14% increase in unit sales (RR = 1.14; p = .01); 100-unit increase in conventional ST tweets was associated with ~1% increase in unit sales (p = .04). Average price was negatively associated with the unit sales. CONCLUSIONS: Study findings reveal that ST social media tweet rate was related to increased ST consumption and illustrate the utility of exogenous measures in conceptualizing and assessing effects in the complex media environment. IMPLICATIONS: Tobacco control initiatives should include efforts to monitor the role of social media in promoting tobacco use. Surveillance of social media platforms is critical to monitor emerging tobacco product-related marketing strategies and promotional content reach. Exogenous measures of potential exposure to social media messages can supplement survey data to study media effects on tobacco consumption.

Youth and Young Adult Blunt Use Predicts Progression to Other Nicotine Product Use in the United States.

BACKGROUND: Little cigars or cigarillos (LCCs) are frequently modified to smoke cannabis ("blunts") by youth and young adults. This study investigated whether young blunt users who are otherwise nicotine-naïve are more likely to initiate other tobacco products compared to never blunt users. METHODS AND MATERIALS: Data were from four waves of the Truth Longitudinal Cohort (TLC), a national probability-based sample of youth and young adults (aged 15-24 years) in the United States (Wave 1: January-April 2017; Wave 2: February-May 2018; Wave 3: February-May 2019; Wave 4: September-December 2019). The sample was restricted to nicotine naïve respondents at Wave 1 with possible ever use of blunts (N = 5,284). Logistic regression analyses tested whether ever blunt use at Wave 1 predicted initiation of nicotine products by Wave 4, controlling for established risk factors. RESULTS: Compared to never-blunt users, ever users of blunts at Wave 1 had significantly higher odds of ever using cigars (OR: 4.74; 95% CI: 1.80-12.47; p = 0.002), e-cigarettes (OR: 4.66; 95% CI: 2.42-8.95; p < 0.001), cigarettes (OR: 3.02; 95% CI: 1.17-7.84, p = 0.023), or hookah (OR: 3.47; 95% CI: 1.07-11.29, p = 0.039) by Wave 4. Cannabis (never blunt) use by Wave 1 predicted ever use of e-cigarettes (OR: 3.45, 95% CI: 2.38-5.02, p < 0.001), cigarettes (OR: 3.81; 95% CI: 2.26-6.43, p < 0.001), or hookah (OR: 2.13; 95% CI: 1.12-4.05, p = 0.021) by Wave 4. DISCUSSION: Blunts are a point of nicotine initiation that places users at increased risk of progression to cigars, while the same relationship was not found for cannabis alone.

Characterising advertising strategies and expenditures for conventional and newer smokeless tobacco products.

OBJECTIVE: Nicotine pouch products are an emerging and rapidly growing smokeless tobacco (ST) category in the USA. Little is known about the promotional strategies and media channels used to advertise this ST category or the extent to which the marketing strategies differ from strategies used to promote 'conventional' smokeless products (eg, snuff). We describe the nature, timing of and expenditures related to conventional, snus and newer ST product advertising on print, broadcast and internet media. METHODS: Advertising expenditures were collected using Kantar Media's 'Stradegy' tool, which provides advertising data including dollars spent promoting specific products across various media channels, including print magazines and newspapers, broadcast television and radio, outdoor posters and billboards, and internet. We identified 306 smokeless products within Kantar database and collected ad expenditures retrospectively for January 2018-April 2020. Promotional expenditures were aggregated by product category, by month and by designated market area (DMA). RESULTS: Kantar data analysis returned 28 conventional ST, 22 oral nicotine and 3 snus products (53 total) advertised during the period of observation, with over $71 million spent collectively on ST promotion. Across categories, more advertising dollars were spent on conventional ST products (63%) than newer oral nicotine products (25%) or snus (12%). However, during the later 9-month period from August 2019 to April 2020, oral nicotine products accounted for the majority of monthly ad spending. Most ad spending was placed in the national market ($66.5 million), with Atlanta ($1.1 million), Houston ($1 million) and Las Vegas ($0.8 million) as the top three local DMAs for expenditures. DISCUSSION: Advertising expenditures for nicotine pouches have recently exceeded conventional ST product advertising and nicotine pouches are being promoted nationally. Marketing surveillance as well as understanding consumer appeal, perceptions and consumption are critical next steps in tracking potential uptake of these new products.

Developing a theoretical marketing framework to analyse JUUL and compatible e-cigarette product promotion on Instagram.

BACKGROUND: E-cigarette promotion on social media coincided with the rapid growth of e-cigarette use among American youth, particularly with the increased JUUL pod vaporiser use. We examined commercial JUUL-related messages on Instagram to identify marketing appeals used to target users along the continuum of e-cigarette use; we mapped the appeals to existing theoretical marketing frameworks to better understand industry strategies. METHODS: Hashtag-based keyword rules were used to collect JUUL-related posts from the Instagram application programming interface, 1 March-13 November 2018. Posts were classified as commercial or non-commercial. A combination of machine learning methods, keyword algorithms and human coding were used to characterise message themes in commercial posts. RESULTS: Keyword filters captured 50 817 relevant posts and 41% were commercial. Among commercial posts, 91% contained recruitment/trial-based appeals (eg, combustible tobacco cessation; product sampling; giveaways) and 71% featured reinforcement/addiction-related appeals (eg, loyalty programmes). None of the commercial messages contained e-cigarette cessation-related appeals and less than 25% mentioned quitting combustible tobacco as a recruitment appeal. CONCLUSIONS: Instagram posts featuring e-cigarette related marketing can increase exposure to persuasive messages encouraging e-cigarette trial and use particularly among susceptible youth. Stronger regulations are needed to prevent exposure to social media marketing among young social media users.

Disclosure Standards for Social Media and Generative Artificial Intelligence Research: Toward Transparency and Replicability.

Social media dominate today's information ecosystem and provide valuable information for social research. Market researchers, social scientists, policymakers, government entities, public health researchers, and practitioners recognize the potential for social data to inspire innovation, support products and services, characterize public opinion, and guide decisions. The appeal of mining these rich datasets is clear. However, there is potential risk of data misuse, underscoring an equally huge and fundamental flaw in the research: there are no procedural standards and little transparency. Transparency across the processes of collecting and analyzing social media data is often limited due to proprietary algorithms. Spurious findings and biases introduced by artificial intelligence (AI) demonstrate the challenges this lack of transparency poses for research. Social media research remains a virtual "wild west," with no clear standards for reporting regarding data retrieval, preprocessing steps, analytic methods, or interpretation. Use of emerging generative AI technologies to augment social media analytics can undermine validity and replicability of findings, potentially turning this research into a "black box" enterprise. Clear guidance for social media analyses and reporting is needed to assure the quality of the resulting research. In this article, we propose criteria for evaluating the quality of studies using social media data, grounded in established scientific practice. We offer clear documentation guidelines to ensure that social data are used properly and transparently in research and applications. A checklist of disclosure elements to meet minimal reporting standards is proposed. These criteria will make it possible for scholars and practitioners to assess the quality, credibility, and comparability of research findings using digital data.

Industry response to strengthened regulations: amount and themes of flavoured electronic cigarette promotion by product vendors and manufacturers on Instagram.

BACKGROUND: Social media discussion tends to follow news about proposed or enacted government policies. Thus, digital discourse surveillance may be an effective and unobtrusive way of understanding industry and public response to policies and regulations, including in the domain of tobacco control. Recently, the US Food and Drug Administration restricted sales of flavoured cartridge and disposable vape products. Historically, the tobacco industry used modification of product characteristics, labelling or packaging to work around flavour restrictions. We aimed to characterise strategies used by nicotine product manufacturers and vendors to promote flavoured products on Instagram and to identify policy workaround tactics. METHODS: Keyword rules were used to collect flavoured electronic cigarette-related Instagram posts from CrowdTangle, from 1 January 2019 to 31 December 2021. Posts were coded for commercial content and promotional strategies using a combination of machine learning methods, keyword algorithms and human coding. Additional exploratory analyses were conducted to identify major discussion themes. Non-English posts were excluded from the analyses. RESULTS: Keyword filters captured 113 393 relevant posts from 391 unique accounts, with 46 076 posts referencing flavour promotion (40.6%) and 2124 (2%) posts mentioning alternatives to restricted flavoured products or strategies to evade flavour sales restrictions. Promotional messages featured non-characterising flavour references, 'off-brand' product substitutes, promotion of new flavoured product technologies, innovation, do-it-yourself appeals, global promotion, international delivery and encouraged flavoured product stockpiling. In addition, promotion of refillable devices, e-juice, tank systems and 'box mod' vaporizers was present. CONCLUSION: Social media surveillance can enhance our understanding of public health needs and policy compliance, as well as inform strategies to prevent policy evasion. Examining evolving industry tactics to promote flavoured products in response to regulatory changes can help authorities and practitioners assess policy effectiveness and inform future design and implementation approaches.

The Influence of Provaping "Gatewatchers" on the Dissemination of COVID-19 Misinformation on Twitter: Analysis of Twitter Discourse Regarding Nicotine and the COVID-19 Pandemic.

BACKGROUND: There is a lot of misinformation about a potential protective role of nicotine against COVID-19 spread on Twitter despite significant evidence to the contrary. We need to examine the role of vape advocates in the dissemination of such information through the lens of the gatewatching framework, which posits that top users can amplify and exert a disproportionate influence over the dissemination of certain content through curating, sharing, or, in the case of Twitter, retweeting it, serving more as a vector for misinformation rather than the source. OBJECTIVE: This research examines the Twitter discourse at the intersection of COVID-19 and tobacco (1) to identify the extent to which the most outspoken contributors to this conversation self-identify as vaping advocates and (2) to understand how and to what extent these vape advocates serve as gatewatchers through disseminating content about a therapeutic role of tobacco, nicotine, or vaping against COVID-19. METHODS: Tweets about tobacco, nicotine, or vaping and COVID-19 (N=1,420,271) posted during the first 9 months of the pandemic (January-September 2020) were identified from within a larger corpus of tobacco-related tweets using validated keyword filters. The top posters (ie, tweeters and retweeters) were identified and characterized, along with the most shared Uniform Resource Locators (URLs), most used hashtags, and the 1000 most retweeted posts. Finally, we examined the role of both top users and vape advocates in retweeting the most retweeted posts about the therapeutic role of nicotine, tobacco, or vaping against COVID-19. RESULTS: Vape advocates comprised between 49.7% (n=81) of top 163 and 88% (n=22) of top 25 users discussing COVID-19 and tobacco on Twitter. Content about the ability of tobacco, nicotine, or vaping to treat or prevent COVID-19 was disseminated broadly, accounting for 22.5% (n=57) of the most shared URLs and 10% (n=107) of the most retweeted tweets. Finally, among top users, retweets comprised an average of 78.6% of the posts from vape advocates compared to 53.1% from others (z=3.34, P<.001). Vape advocates were also more likely to retweet the top tweeted posts about a therapeutic role of nicotine, with 63% (n=51) of vape advocates retweeting at least 1 post compared to 40.3% (n=29) of other top users (z=2.80, P=.01). CONCLUSIONS: Provaping users dominated discussions of tobacco use during the COVID-19 pandemic on Twitter and were instrumental in disseminating the most retweeted posts about a potential therapeutic role of tobacco use against the virus. Subsequent research is needed to better understand the extent of this influence and how to mitigate the influence of vape advocates over the broader narrative of tobacco regulation on Twitter.

Discussions of Flavored ENDS Sales Restrictions: Themes Related to Circumventing Policies on Reddit.

OBJECTIVE: To examine conversations among JUUL users on Reddit related to restrictions on flavored ENDS and the shifting policy landscape. METHODS: Posts and comments (n = 166,169) between May 2019 and May 2020 on the subreddit r/JUUL were scraped using pushshift.io API. Keyword filters were used to identify texts discussing flavored ENDS products (n = 33,884 texts). These were further narrowed down to texts discussing flavor policy workaround strategies (n = 7429) and N-gram analysis was performed. Finally, findings from the N-gram analysis were triangulated through qualitative review of a separate sample of texts (n = 488) from the flavor policy-related posts and comments. RESULTS: Overall activity on the subreddit r/JUUL peaked around the time of the EVALI outbreak (September 2019) and when FDA issued guidance restricting flavored ENDS product sales (January 2020). The N-gram analysis revealed an active discussion of banned products one can "still get" or "JUUL compatible" alternatives, including specific brands, brick and mortar locations, and specific flavors. Ten dominant themes emerged from the qualitative review, with some posts containing more than one theme. CONCLUSION: Many users turned to Reddit for information related to the shifting regulatory landscape concerning flavored ENDS. Discussions focused on both legal alternatives to banned products as well as illegal means of acquiring JUUL pods, including residual retail supply, online, and mail vendors.

Online Tobacco Advertising and Current Chew, Dip, Snuff and Snus Use among Youth and Young Adults, 2018-2019.

OBJECTIVE: To understand the relationship between exposure to online tobacco advertising and current smokeless tobacco use in the context of tobacco control policies. METHODS: Three waves of a national probability-based sample of (n = 15,985) youth and young adults were used. Analysis consisted of GEE logistic models controlling for social media use, demographics, tobacco use, average price of smokeless tobacco inclusive of taxes, smoke-free indoor air laws (SFIA) and state tobacco control expenditures. RESULTS: Frequent exposure to tobacco advertising on social media is associated with greater odds of current smokeless use (aOR: 2.05, 95% CI: 1.62, 2.60). Higher prices and SFIA coverage were associated with reduced current smokeless use when examined separately from other tobacco policy variables (aOR: 0.79, CI: 0.73, 0.85; aOR: 0.44, CI: 0.28, 0.70). CONCLUSIONS: Greater exposure to tobacco advertising online is associated with greater odds of smokeless use among surveyed youth and young adults. This effect of social media marketing exposure on smokeless use outweighs the mitigating impact of existing tobacco control policies. The findings underscore the need for strong advertising regulation of evolving tobacco products, including smokeless products, on social media and surveillance of digital marketing tactics to young people.

Promoting corporate image or preventing underage use? Analysis of the advertising strategy and expenditures of the JUUL parent education for youth vaping prevention campaign.

OBJECTIVE: In April 2018, JUUL Labs announced a $30 million investment in efforts to combat underage use of its products through 'independent research, youth and parent education and community engagement'. Prior evidence demonstrates that tobacco industry-funded prevention programmes are ineffective and may work against tobacco control efforts; they do not discourage novices and youth from tobacco use but often improve the tobacco industry's public image. We describe the nature, timing of and expenditures related to the JUUL underage use prevention advertisements across media channels. METHODS: Expenditures for newspaper, magazine, television, and radio marketing and promotional efforts were collected through Kantar Media's 'Stradegy' dashboard, an online platform which provides counts of advertisement occurrences and expenditures on various media channels. JUUL public relations and corporate social responsibility ads were identified in the Kantar Database. All ad expenditures were extracted and aggregated by date. Analysis of the expenditure data was triangulated with newspaper and industry advertisement archives. RESULTS: Advertisements aired nationally and in over half of all US-designated market areas (n=130) across media platforms including newspapers, magazines, radio, and online in mobile web and internet displays. In 2018, JUUL Labs spent $30 million, predominantly for print advertising. The 'What Parents Need to Know about JUUL' ads primarily advertised JUUL's smoking reduction 'mission' and promoted the product. By 2019, advertising increased to $36.2 million. JUUL's message strategy transitioned to 'Cracking Down on Underage Sales in Retail Stores' and featured adult smoker testimonies, linking JUUL to smoking cessation. DISCUSSION: Marketing expenditures promoting JUUL's corporate social responsibility mission exceeded their $30 million investment in the underage use prevention efforts. The expenditures were focused on the media market areas where health organisation and legislative officials were launching investigations into JUUL social media and other promotional strategies.

Heating Up: How Early Twitter Marketing Gave Rise to Organic Word-of-Mouth About Heated Tobacco Products.

Social media are an important marketing platform for emerging tobacco products. Heated tobacco products (HTPs) have been introduced in a limited number of local test markets in the United States as potentially reduced-exposure tobacco products. HTPs can be used to heat tobacco as well as marijuana. However, due to growing digital media promotion of these products, it is possible that public knowledge and purchasing opportunities extend beyond test markets. Research on HTP social media promotion is sparse. The objective of the present study is to assess the amount and characterize the content of HTP-related messages on Twitter. We used keyword rules to collect HTP-related posts from the Twitter Historical Powertrack from 1 August 2016 to 31 July 2021. Posts were coded for type (organic, commercial), promotional strategies (e.g., discounts, event promotion), and marijuana co-use mentions using a combination of machine learning methods and human coding. Keyword filters captured 121,012 relevant tweets posted over the period of data collection, with 46,013 (38.02%) tweets featuring commercial content. Findings revealed that there was a two-fold increase in the monthly volume of messages from August 2016 to July 2021. The proportion of organic tweets increased from 29% of all tweets in August 2016 to 73.5% in July 2021. Approximately 20.6% of tweets included mentions of marijuana, and 5,243 posts (4.3%) contained links to online retailers. Promotional tweets featured event promotion, discounts, reduced harm appeals, and fashion appeals. Tobacco control and substance use prevention initiatives should include efforts to monitor the role of social media in promoting organic word-of-mouth and normalizing novel tobacco products.

#toolittletoolate: JUUL-related content on Instagram before and after self-regulatory action.

INTRODUCTION: Digital e-cigarette marketing is largely unregulated and remains easily accessible to young people. The growing public concern around youth JUUL use and its viral presence on social media led the company to engage in several voluntary actions to remove and reduce JUUL-related content on Instagram in May 2018. The current study examined how JUUL-related Instagram content changed in the US following JUUL Labs' wave of voluntary actions in May 2018. METHODS: In 2019, we collected a total of 50,817 JUUL-relevant posts by 16,323 unique users on Instagram from March 1-May 15, 2018 (Phase 1) and May 16-November 11, 2018 (Phase II) using the application programming interface. We conducted a semantic network analysis to identify major topic clusters over time. RESULTS: Approximately 14,838 JUUL-related posts were made by 5,201 accounts in Phase I and 35,979 posts were made by 11,122 accounts in Phase II. Major content clusters remained unchanged over time-key topics were JUUL-related product characteristics and JUUL-communities; the general vape community; and cannabis-related behavior. Of note, cannabis-related content grew in Phase II, particularly use of the term CBD. CONCLUSIONS: Our results reflect the limits of voluntary industry actions to reduce or change vaping-related content on social media. Rather, strong federal restriction on commercial tobacco marketing is the optimal pathway to reduce initial product marketing exposure among youth. These limits would make the emergence and viral contagion of brand-related social media content less likely and reduce its influence on youth behavior.

Characterising JUUL-related posts on Instagram.

BACKGROUND: JUUL, a high-tech, popular vaping device, was the first major electronic cigarette (e-cigarette) brand to incorporate social media into its marketing strategy. There is growing concern around the increasing use of JUUL and other electronic nicotine delivery devices among youth, and their potential to addict a new generation to nicotine. The current study analysed the amount and characteristics of JUUL-related posts on Instagram, a social media platform used frequently among youth and young adults. METHODS: Hashtag-based keyword queries (n=50) were used to collect JUUL-related posts from the Instagram application programming interface, March 2018-May 2018. Using a combination of machine learning methods, keyword algorithms and human coding, posts were characterised as featuring content related to product promotion, nicotine and addiction, youth culture and lifestyle. RESULTS: Keyword queries captured 14 838 JUUL-relevant posts by 5201 unique users. Over one-third of posts were promotional (eg, linked to commercial website) and 11% contained nicotine and addiction-related information. Approximately half of posts featured content related to youth (55%) or lifestyle (57%). Youth-related content or lifestyle appeals were also notably present within promotional posts and nicotine and addiction-related posts, respectively. Nicotine and addiction-related posts featured memes, hashtags (eg, #nichead, #juulbuzz) and tag lines (eg, 'more flavor, more buzz'). CONCLUSIONS: Findings reveal a proliferation of JUUL-related content on Instagram, which focused on product promotion and nicotine and addiction that included youth culture and lifestyle appeals. Regulatory actions should focus on restricting promotional efforts for e-cigarette products, particularly on social media platforms where young people are a primary audience.

Exposure and reach of the US court-mandated corrective statements advertising campaign on broadcast and social media.

OBJECTIVE: As a remedy to committing fraud and violating civil racketeering laws, in November 2017, four major tobacco companies were court-ordered to develop and disseminate corrective statements regarding smoking health risks using mass media channels. We aimed to describe the nature, timing, reach of and exposure to the court-mandated tobacco industry corrective advertising campaign on social, broadcast and print media. METHODS: Data from social, print and broadcast media were used to measure potential exposure to corrective messages. Keyword rules were used to collect campaign-related posts from the Twitter Firehose between November 2017 and January 2018. Data were analysed using a combination of machine learning, keyword algorithms and human coding. Posts were categorised by source (commercial/institutional, organic) and content type (eg, sentiment). Analysis of social media data was triangulated with ratings data for television advertising and print advertising expenditure data. RESULTS: Keyword filters retrieved 13 846 tweets posted by 9232 unique users. The majority of tweets were posted by institutional/commercial sources including news organisations, bots and tobacco control-related accounts and contained links to news and public health-related websites. Approximately 60% of campaign-related tweets were posted during the first week of campaign launch. Household exposure to the televised corrective advertisements averaged 0.56 ads per month. DISCUSSION: The corrective campaign failed to generate social media engagement. The size and timing of the advertising buys were not consistent with strategies effective in generating high sustained impact and audience reach, particularly among youth.

Tobacco industry use of flavourings to promote smokeless tobacco products.

BACKGROUND: While fruit, candy and alcohol characterising flavours are not allowed in cigarettes in the USA, other flavoured tobacco products such as smokeless tobacco (ST) continue to be sold. We investigated tobacco manufacturers' use of flavoured additives in ST products, the target audience(s) for flavoured products, and marketing strategies promoting products by emphasising their flavour. METHODS: Qualitative analysis of internal tobacco industry documents triangulated with data from national newspaper articles, trade press and internet. RESULTS: Internally, flavoured products have been consistently associated with young and inexperienced tobacco users. Internal studies confirmed that candy-like sweeter milder flavours (eg, mint, fruit) could increase appeal to starters by evoking a perception of mildness, blinding the strong tobacco taste and unpleasant mouth feel; or by modifying nicotine delivery by affecting product pH. DISCUSSION: Similar to cigarettes, flavoured ST is likely to encourage novices to start using tobacco, and regulations limiting or eliminating flavours in cigarettes should be extended to include flavoured ST products.

'Sweeter Than a Swisher': amount and themes of little cigar and cigarillo content on Twitter.

OBJECTIVE: Despite recent increases in little cigar and cigarillo (LCC) use-particularly among urban youth, African-Americans and Latinos-research on targeted strategies for marketing these products is sparse. Little is known about the amount or content of LCC messages users see or share on social media, a popular communication medium among youth and communities of colour. METHODS: Keyword rules were used to collect tweets related to LCCs from the Twitter Firehose posted in October 2014 and March-April 2015. Tweets were coded for promotional content, brand references, co-use with marijuana and subculture references (eg, rap/hip-hop, celebrity endorsements) and were classified as commercial and 'organic'/non-commercial using a combination of machine learning methods, keyword algorithms and human coding. Metadata associated with each tweet were used to categorise users as influencers (1000 and more followers) and regular users (under 1000 followers). RESULTS: Keyword filters captured over 4 372 293 LCC tweets. Analyses revealed that 17% of account users posting about LCCs were influencers and 1% of accounts were overtly commercial. Influencers were more likely to mention LCC brands and post promotional messages. Approximately 83% of LCC tweets contained references to marijuana and 29% of tweets were memes. Tweets also contained references to rap/hip-hop lyrics and urban subculture. CONCLUSIONS: Twitter is a major information-sharing and marketing platform for LCCs. Co-use of tobacco and marijuana is common and normalised on Twitter. The presence and broad reach of LCC messages on social media warrants urgent need for surveillance and serious attention from public health professionals and policymakers. Future tobacco use prevention initiatives should be adapted to ensure that they are inclusive of LCC use.