Perceptions of HPV-Linked Oropharyngeal Cancer Risk Messages Among a Sample of Young Adult Men in the US: A Pilot Study.

Awareness of risk for oropharyngeal cancer from oral human papillomavirus (HPV) infection is low among men in the United States. This pilot study tested messages communicating oral HPV and oropharyngeal cancer risk among a sample of U.S. young adult men (aged 18-26). Six oral HPV and cancer risk messages were tested in an online survey. Participants (N = 68) were randomly assigned to one of two message sets, each containing three unique text-based messages. Participants evaluated messages separately based on various measures (e.g., perceived message effectiveness [PME], novelty). One-way repeated measures ANOVAs were used to assess evaluation differences within message sets. Participants provided open-ended feedback about each message, which were synthesized into overarching themes. Participants were receptive to the risk messages, rating them high on PME (mean range = 3.72-4.25 out of 5) and other measures. Analyses identified three high-performing messages. For example, participants rated a message about HPV-linked oropharyngeal cancer risk rates in men versus women higher on attention and novelty than two other messages in the same set (both ps < .05). Participants were shown three messages (instead of all six) in each message set to minimize survey fatigue. Common themes from open-ended feedback were that participants liked the short-form structure of the messages and that the messages used gender-tailored language. In conclusion, oral HPV and oropharyngeal cancer risk messages may be useful for increasing risk awareness among men in the U.S. Further work should test such messages in rigorous experimental contexts to assess their efficacy in modifying other health outcomes, such as HPV vaccination behaviors.

Mitigating Health and Science Misinformation: A Scoping Review of Literature from 2017 to 2022.

Literature on how to address misinformation has rapidly expanded in recent years. The aim of this scoping review was to synthesize the growing published literature on health and science misinformation mitigation interventions. English-language articles published from January 2017 to July 2022 were included. After title/abstract screening, 115 publications (148 empirical studies) met inclusion criteria and were coded for sample characteristics, topics, mitigation strategies, research methods, outcomes, and intervention efficacy. A marked increase in misinformation mitigation research was observed in 2020-2022. COVID-19, vaccines, and climate change were the most frequently addressed topics. Most studies used general population samples recruited online; few focused on populations most vulnerable to misinformation. Most studies assessed cognitive outcomes (e.g., knowledge), with fewer assessing health behavior, communication behavior, or skills. Correction (k = 97) was the most used misinformation mitigation strategy, followed by education and other literacy initiatives (k = 39) and prebunking/inoculation (k = 24). Intervention efficacy varied, with 76 studies reporting positive, 17 reporting null, and 68 reporting mixed results. Most misinformation mitigation interventions were limited to short-term online experiments focused on improving cognitive outcomes. Priority research areas going forward include expanding and diversifying study samples, scaling interventions, conducting longitudinal observations, and focusing on communities susceptible to misinformation.

Analysis of Telehealth Discussion Trends on Reddit (2019-2022).

Introduction: Use of telehealth increased during the COVID-19 pandemic and continues to be a popular health resource. This study analyzed the frequency and sentiment of telehealth discussions on Reddit. Methods: The data set included 13,071 publicly available Reddit submissions containing keywords related to telehealth over a 3-year period. We identified 173 unique subreddit communities, which were coded into mutually exclusive categories: (1) general telehealth, (2) individual care, (3) professional, (4) news, and (5) COVID-19. The Vader lexicon-based machine was used to assign sentiment scores. Results: Most subreddits were coded as individual care (n = 112), professional (n = 26), and news (n = 22). The frequency of submissions increased during the first 2 months of the pandemic and dropped in June 2020, but remained consistent through October 2022. Most Reddit submissions were positive in sentiment (56%). Conclusion: Findings show a mostly positive view of telehealth among Reddit users and an increase in telehealth-related discussions since the COVID-19 pandemic.

Health discussion network characteristics among a sample of people with inflammatory bowel disease.

OBJECTIVES: This study examined the health discussion networks (HDNs) of people with inflammatory bowel disease (IBD). We sought to test if HDN characteristics were associated with IBD management self-efficacy outcomes. METHODS: We recruited a sample of adults with IBD (N = 112) in December 2020 to take an online survey. Participants listed up to five people (alters) who they discussed their health with, and we used those data to construct individual HDNs. Participants provided demographic information about alters, and characterized alter by relationship, closeness, and support provided. We used multivariable regression to examine associations of HDN characteristics with IBD symptoms, remission, and emotions management self-efficacy outcomes. RESULTS: Participants reported data for 412 alters (mean HDN size: 3.68). Alters were mostly friends (40%) or family members (36%); few were healthcare workers (6%). In multivariable analyses, HDN size was associated with remission and emotions management self-efficacy (ps < .05), and the amount of support offered by alters was associated with emotions management self-efficacy (p < .05). DISCUSSION: HDN size and alter support variables were associated with some IBD management self-efficacy outcomes among our study sample. These findings provide empirical evidence about HDNs among people with IBD and support the notion that disease management is a collective effort.

Examining the Longitudinal Relationship Between Perceived and Actual Message Effectiveness: A Randomized Trial.

We sought to examine the relationship between perceived message effectiveness (PME) and actual message effectiveness (AME) in a 3-week randomized trial of vaping prevention advertisements. Participants were US adolescents (n = 1,514) recruited in 2021. We randomly assigned them to view The Real Cost vaping prevention ads or control videos online. Participants viewed three videos at Visit 1, again at Visits 2 and 3, and completed a survey at each visit that assessed AME (susceptibility to vaping) and two types of PME - effects perceptions (potential for behavioral impact) and message perceptions (potential for message processing). At Visit 4, AME was measured. Compared to control, The Real Cost ads led to improved AME (lower susceptibility to vaping at Visit 4, p < .001). This was anticipated by The Real Cost ads eliciting higher PME ratings (higher effects and message perceptions at Visit 1, both p < .001). Furthermore, PME (both effects and message perceptions) at Visit 1 predicted susceptibility to vaping at Visits 1, 2, 3, and 4 (all p < .001). Finally, effects perceptions fully mediated the impact of The Real Cost ads on susceptibility to vaping (ß = -.30; p < .001), while message perceptions only partially mediated the effect (ß = -.04; p = .001). Our findings indicate a relationship between PME and AME, especially effects perceptions, and suggest that PME may be useful in message pre-testing to select messages with greater behavior change potential.

Community and Opinion Leadership Effects on Vaping Discourse: A Network Analysis of Online Reddit Threads.

Reddit is a popular hub for discussing vaping. A deeper understanding of the factors that influence this online discourse could inform public health messaging efforts targeting this platform. Using a network analysis framework, we sought to investigate the role of opinion leaders and online communities in facilitating vaping discussions on Reddit. We collected Reddit submissions about vaping posted in May 2021 and used these submissions to generate subreddit-level (N=261) and thread-level (N=8,377) data sets. We coded subreddits into four community categories: 1) Vaping, 2) Substance use, 3) Cessation, and 4) Non-specific. We used sociometric in-degree centrality statistics to identify subreddit opinion leaders. We computed non-parametric ANOVAs and negative binomial regressions to test associations between opinion leadership and subreddit community category variables on subreddit network composition (comprised of subreddit-level network nodes and edges) and the number of commenters on Reddit threads about vaping (thread-level). Subreddit network composition was largely dependent on opinion leaders in Non-specific communities, and less so in Vaping and Substance use communities. At the thread-level, the rate of commenters was higher among threads initiated by opinion leaders than non-opinion leaders (adjusted rate ratio [aRR]=4.84). Furthermore, threads posted in Vaping (aRR=1.64), Substance use (aRR=1.92), and Cessation (aRR=1.21) communities had higher commenter rates than those posted in Non-specific communities. Communities and opinion leaders play a key role in the composition and reach of vaping discussions on Reddit. These findings provide a foundation for public health campaigns and interventions targeting Reddit and perhaps other social media platforms.

Impact of Vaping Prevention Advertisements on US Adolescents: A Randomized Clinical Trial.

Importance: Understanding whether prevention advertisements reduce susceptibility to vaping is important owing to concerning levels of adolescent vaping. Objective: To examine whether vaping prevention advertisements from the US Food and Drug Administration (FDA) national Real Cost campaign lead to lower susceptibility to vaping among adolescents. Design, Setting, and Participants: For this 3-group randomized clinical trial with parallel assignment, participants were US adolescents aged 13 to 17 years who were susceptible to vaping or current e-cigarette users, recruited from online panels. Adolescents were randomized to 1 of 2 Real Cost vaping prevention trial groups (health harms- or addiction-themed advertisements) or to a control group (investigator-created neutral videos about vaping). Adolescents completed 4 weekly online surveys at visits 1 to 4 over a 3-week period. Data were analyzed from December 1, 2021, to August 25, 2022. Interventions: Adolescents saw 3 randomly ordered 30-second video advertisements online at each of 3 weekly study visits (visits 1, 2, and 3). Main Outcomes and Measures: The primary trial outcome was susceptibility to vaping. Surveys also assessed susceptibility to smoking cigarettes to examine any spillover effects of vaping prevention advertisements on smoking outcomes. Both susceptibility measures had 3 items and ranged from 1 (indicating not susceptible) to 4 (indicating highly susceptible). The primary analyses compared Real Cost groups (combined) with the control group, while exploratory analyses compared the Real Cost groups with each other. Results: Participants were 1514 adolescents (1140 [75.3%] boys; mean [SD] age, 15.22 [1.18] years), including 504 randomized to the Real Cost health harms group, 506 randomized to the Real Cost addiction group, and 504 randomized to the control group. Adolescents in the Real Cost groups (combined) had lower susceptibility to vaping at visit 4 than those in the control group (b = -0.21; 95% CI, -0.32 to -0.10). The Real Cost groups did not differ from one another on susceptibility to vaping (visit 4: b = -0.05; 95% CI, -0.17 to 0.07). Adolescents in the Real Cost groups (combined) also had lower susceptibility to smoking cigarettes than those in the control group (b = -0.21; 95% CI, -0.32 to -0.10). For both vaping and smoking, Real Cost groups had less positive attitudes (vaping: b = -0.27; 95% CI, -0.40 to -0.14; smoking: b = -0.23; 95% CI, -0.39 to -0.08) compared with the control group. Conclusions and Relevance: These findings suggest that vaping prevention advertisements from the FDA Real Cost campaign led to lower adolescent susceptibility to vaping and had beneficial spillover effects on cigarette smoking outcomes. Tobacco prevention campaigns can help reduce youth tobacco use. Trial Registration: ClinicalTrials.gov Identifier: NCT04836455.

A Self-management SMS Text Messaging Intervention for People With Inflammatory Bowel Disease: Feasibility and Acceptability Study.

BACKGROUND: Mobile health technologies can be useful for providing disease self-management information and support to people with inflammatory bowel disease (IBD). OBJECTIVE: The aim of this study was to test a self-management SMS text messaging intervention for people with IBD. Our goal was to examine intervention feasibility, acceptability, and engagement and to preliminarily evaluate improvements in certain self-reported health outcomes among participants. METHODS: We developed an SMS text messaging program called Text4IBD. The program sent daily support messages and resources about disease self-management over the course of a 2-week, single-group, pretest-posttest intervention to participants (N=114) diagnosed with IBD. We examined intervention feasibility, acceptability, and engagement through Text4IBD message topic recall and use of resources (ie, visiting supplemental websites recommended by the Text4IBD program). We also assessed pretest-posttest measures of IBD-related distress, self-efficacy, perceived support, use of coping strategies, and medication adherence. Analyses examined participants' evaluations of the intervention and compared pretest-posttest changes in secondary outcomes using paired-samples statistics. RESULTS: Approximately all participants who completed the intervention (n=105) were receptive to Text4IBD and viewed the program as feasible and acceptable. In addition, most participants (103/105, 98.1%) recalled at least one of the message topics sent by the program, and 79% (83/105) of them self-reported engaging with at least one of the external self-management resources recommended by the Text4IBD program. Pretest-posttest results showed reduced IBD-related distress (mean 3.33, SD 0.68 vs mean 2.86, SD 0.73; P<.001) and improvements in most other secondary outcomes. CONCLUSIONS: Findings from this study highlight the value of SMS text messaging as a useful digital medium for providing support to people with IBD, particularly to those who may struggle with disease-related distress. Text4IBD was highly feasible and acceptable and may help people self-manage their IBD. Future studies should aim to evaluate this program in a randomized controlled trial in clinical settings.

Identifying Promising Themes for Adolescent Vaping Warnings: A National Experiment.

INTRODUCTION: Adolescent vaping remains a problem in the United States, yet little is known about what health warning themes most discourage vaping among adolescents. We sought to identify the most compelling themes for vaping warnings for US adolescents. METHODS: Participants were a national probability sample of 623 US adolescents aged 13-17 years, recruited in the summer of 2020. Adolescents were randomized to one of the five warning message themes about the potential health effects of vaping: 1. chemical harms, 2. lung harms, 3. Coronavirus Disease 2019 (COVID-19) harms, 4. nicotine addiction, or 5. control (messages about vape litter). The primary outcome was perceived message effectiveness (PME; 3-item scale). Secondary outcomes were negative affect (fear), attention, anticipated social interactions, and message novelty. RESULTS: Adolescents rated the chemical, lung, and COVID-19 harms warning messages higher on PME than nicotine addiction and control (all p < .05), while nicotine addiction was rated higher than control (p < .05). The chemical, lung, and COVID-19 harms warning themes also elicited greater negative affect than nicotine addiction and control (all p < .05). For all other secondary outcomes, the COVID-19 harms warning message theme was rated higher than nicotine addiction and control (all p < .05). CONCLUSION: Adolescents perceived warning message themes about lung, chemical and COVID-19 health effects of vaping as more effective than nicotine addiction. To discourage vaping, the FDA and others should communicate to youth about the health effects of vaping beyond nicotine addiction. IMPLICATIONS: Adolescents rated warning message themes about the lung, chemical, and COVID-19 health effects of vaping as more effective than nicotine addiction, while nicotine addiction was rated as more effective than control themes about vaping litter. To discourage vaping among adolescents, health messaging should expand message themes to communicate about a broader set of health effects of vaping beyond nicotine addiction.

Adolescents and Young Adults Who Vape or Are Susceptible to Vaping: Characteristics, Product Preferences, and Beliefs.

INTRODUCTION: This study examined differences among current vapers, those susceptible to vaping, and those non-susceptible to vaping among adolescents and young adults (AYAs) in the U.S. We sought to understand vaping-related characteristics, preferences, and beliefs across these populations to inform prevention efforts. Methods: Participants were N=543 adolescents and N=557 young adults recruited in mid-2019 in the U.S. In two separate cross-sectional surveys, we assessed vaping preferences, tobacco product use, and both health harm and addiction risk beliefs about vaping. We ran separate multivariate logistic regressions to assess differences in risk beliefs across the three distinct e-cigarette groups among AYAs. Results: A majority of AYAs were either current vapers (adolescents: 32%, young adults: 36%) or susceptible to vaping (adolescents: 34%, young adults: 24%). In both samples, pod-based devices were the most common device type used, and fruit and mint/menthol were the most commonly used flavors. In multivariate analyses, adolescent (p<.05) and young adult (p<.05) current vapers both had lower risk beliefs about the health harms of vaping compared to those susceptible to vaping. Susceptible adolescents also had lower health harm risk beliefs compared to those who were non-susceptible (p<.05). Addiction risk beliefs seldom predicted use or susceptibility in multivariate analyses, with only susceptible young adults having lower addiction beliefs than those non-susceptible (p<.05). Conclusion: Results from this study highlight the role of health harm risk beliefs among AYA vapers and those susceptible to vaping. Prevention efforts should examine the most potent ways to communicate vaping health harms to discourage AYA vaping.

Topics Analysis of Reddit and Twitter Posts Discussing Inflammatory Bowel Disease and Distress From 2017 to 2019.

Background: Social media platforms are popular tools for people with inflammatory bowel disease (IBD) to seek support. In the current study, we sought to examine and characterize IBD and distress discourse on public social media platforms. Our goal was to identify topics associated with these online discussions. Methods: We collected public social media posts about IBD and distress from Reddit (N = 40 625) and Twitter (N = 40 306) published between September 2017 and August 2019. We created a term-based dictionary to characterize posts based on 8 different, nonmutually exclusive topics: (1) symptoms, (2) medication, (3) nutrition, (4) procedures, (5) marijuana, (6) stigma, (7) ostomy, and (8) intimacy. We used descriptive statistics to characterize the frequency and order the prevalence of the topics on the 2 platforms, and to assess topic co-occurrences among posts. Results: Most Reddit (79%) and Twitter (56%) posts mentioned at least 1 IBD topic. The order of topic prevalence was the same for the 2 platforms. Symptoms was the most mentioned topic (Reddit: 57%, Twitter 36%), followed by medication (Reddit: 30%, Twitter 11%), and nutrition (Reddit: 27%, Twitter 9%). Intimacy was the least mentioned topic (Reddit: 2%, Twitter: <1%). Topic co-occurrences varied by platform. Most Reddit posts (57%) mentioned at least 2 IBD topics, whereas only 27% of tweets mentioned multiple IBD topics. Conclusions: This study contributes to a growing literature examining how IBD is discussed on social media-specifically, in distress-related contexts on Reddit and Twitter. These cross-platform findings highlight important areas potentially associated with IBD-related distress, which could help facilitate future support.

Impact of eHealth technologies on patient outcomes: a meta-analysis of chronic gastrointestinal illness interventions.

Gastrointestinal (GI) illness interventions are increasingly utilizing eHealth technologies, yet little is currently known about the extent of their impact on patient outcomes. The purpose of this study was to conduct a meta-analysis of the GI eHealth intervention literature. We used a comprehensive search strategy to locate studies. To be included, studies had to be a randomized controlled trial comparing an eHealth intervention condition against a no-treatment or waitlist control condition. Studies had to report data on at least one of the following patient outcomes: medication adherence, quality of life (QoL), psychological distress, illness-related knowledge, or number of patient visits to the clinic/hospital. Analyses weighted effect sizes (d) by their inverse variance and combined them using random effects meta-analytic procedures. K = 19 studies conducted in eight countries with a cumulative sample size of N = 3,193 were meta-analyzed. Findings indicated that GI eHealth interventions improved patients' QoL (d = .25, p = .008), psychological distress (d = .24, p = .017), medication adherence (d = .17, p = .014), and illness-related knowledge (d = .19, p = .002). GI eHealth interventions also significantly reduced the number of patient visits to the clinic/hospital (d = .78, p = .005). Our findings suggest that eHealth interventions hold promise in improving patient outcomes for those with GI illnesses. We suggest the next generation of GI interventions continue developing and evaluating the impact of technology using randomized controlled trial designs, and perhaps consider adapting existing efficacious interventions for burgeoning platforms, such as smartphones and tablets.

Comparison of Message and Effects Perceptions for The Real Cost E-Cigarette Prevention Ads.

Perceived message effectiveness (PME) is commonly used in health communication research and practice, yet there has been a dearth of studies comparing different operationalizations of the PME construct. In the present study, we compared the two major types of PME - message perceptions and effects perceptions - among N = 557 young adults. Participants were randomized to one of two conditions: 1) The Real Cost e-cigarette prevention ads developed by the Food and Drug Administration (FDA condition) or 2) information-only e-cigarette control ads developed by the Mayo Clinic (control ad condition). Study predictors were message and effects perceptions measures and actual message effectiveness (AME) outcomes were risk beliefs about vaping and intentions to vape. Results showed that both message perceptions (M = 3.82 vs M = 3.29; p < .001) and effects perceptions (M = 4.13 vs M = 3.82; p < .001) were higher in the FDA ad condition compared to control. Risk beliefs about vaping were also higher in the FDA ad condition than control (M = 3.95 vs M = 3.79; p =.022), but we found no differences in participants' intentions to vape, which were low overall (M = 1.59 in FDA vs M = 1.58 in control). In multivariate analyses adjusting for covariates and including both types of PME, only effects perceptions (not message perceptions) were associated with risk beliefs about vaping (b =.37, p < .001) and intentions to vape (b = -.26, p < .001). Our findings advance PME research by demonstrating the differing nature of message and effects perceptions, and suggest that effects perceptions should be utilized during message pretesting.

Pictorial Cigarette Pack Warnings Increase Some Risk Appraisals But Not Risk Beliefs: A Meta-Analysis.

Pictorial warnings on cigarette packs motivate smokers to quit, and yet the warnings' theoretical mechanisms are not clearly understood. To clarify the role that risk appraisals play in pictorial warnings' impacts, we conducted a meta-analysis of the experimental literature. We meta-analyzed 57 studies, conducted in 13 countries, with a cumulative N of 42,854. Pictorial warnings elicited greater cognitive elaboration (e.g., thinking about the risks of smoking; d = 1.27; p < .001) than text-only warnings. Pictorial warnings also elicited more fear and other negative affect (d = .60; p < .001). In contrast, pictorial warnings had no impact on perceived likelihood of harm (d = .03; p = .064), perceived severity (d = .16; p = .244), or experiential risk (d = .06; p = .449). Thus, while pictorial warnings increase affective and some cognitive risk appraisals, they do not increase beliefs about disease risk. We discuss the role of negative affect in warning effectiveness and the implications for image selection and warning implementation.

Evaluating the actual and perceived effectiveness of E-cigarette prevention advertisements among adolescents.

BACKGROUND: The efficacy of e-cigarette prevention ads among adolescents has seldom been studied. We examined the impact of ads from the The Real Cost vaping prevention media campaign on what adolescents think and believe about vaping. We also sought to test whether perceived message effectiveness (PME) served as a proxy for ad impact. METHODS: Participants were 543 U.S. adolescents ages 13-17. In an online experiment, we randomized participants to either: 1) persuasive e-cigarette prevention video ads from the Food and Drug Administration's The Real Cost campaign that was targeted to adolescents or 2) information-only e-cigarette harms control videos (control condition). Participants in each condition viewed 2 videos in a random order. After ad exposure, the survey assessed PME (message and effects perceptions), risk beliefs about vaping, attitudes toward vaping, and intentions to vape. RESULTS: The FDA's The Real Cost ads led to higher beliefs about the harms of vaping (p < .001), more negative attitudes toward vaping (p < .001), and lower intentions to vape (p < .05) compared to the control videos. The Real Cost ads also scored higher on both message perceptions (p < .001) and effects perceptions (p < .001) compared to control videos. Effects perceptions were associated with all three outcomes (all ps < 0.001, adjusting for both types of PME and covariates), but message perceptions did not offer additional predictive value. CONCLUSIONS: Exposure to The Real Cost vaping prevention ads gave adolescents a more negative view of vaping and lowered their intentions to vape compared to control videos. Effects perceptions may be superior to message perceptions as a proxy for e-cigarette prevention ad impact.

E-Cigarette Health Harm Awareness and Discouragement: Implications for Health Communication.

INTRODUCTION: Evidence for the health harms of e-cigarettes is growing, yet little is known about which harms may be most impactful in health messaging. Our study sought to identify which harms tobacco product users were aware of and which most discouraged them from wanting to vape. METHODS: Participants were a convenience sample of 1,872 U.S. adult e-cigarette-only users, cigarette-only smokers, and dual users recruited in August 2018. In an online survey, participants evaluated 40 e-cigarette harms from seven categories: chemical exposures, device explosions, addiction, cardiovascular harm, respiratory harm, e-liquid toxicity, and other harms. Outcomes were awareness of the harms ("check all that apply") and the extent to which the harms discouraged vaping (5-point scale; (1) "not at all" to (5) "very much"). RESULTS: Awareness of most e-cigarette harms was modest, being highest for harms in the device explosions category of harms (44%) and lowest for the e-liquid toxicity category (16%). The harms with the highest mean discouragement from wanting to vape were the respiratory harm (M = 3.82) and exposure to chemicals (M = 3.68) categories. Harms in the addiction category were the least discouraging (M = 2.83) compared with other harms (all p < .001). Findings were similar for e-cigarette-only users, cigarette-only smokers, and dual users. CONCLUSIONS: Addiction was the least motivating e-cigarette harm, a notable finding given that the current FDA e-cigarette health warning communicates only about nicotine addiction. The next generation of e-cigarette health warnings and communication campaigns should highlight other harms, especially respiratory harms and the chemical exposures that may lead to health consequences. IMPLICATIONS: E-cigarette health harms related to respiratory effects, chemical exposures, and other health areas most discouraged vaping among tobacco users. In contrast, health harms about addiction least discouraged use. Several countries have begun implementing e-cigarette health warnings, including the United States, and many others are considering adopting similar policies. To increase impact, future warnings and other health communication efforts should communicate about health harms beyond addiction, such as the effects of e-cigarette use on respiratory health. Such efforts should communicate that e-cigarette use is risky and may pose less overall risk to human health than smoking, according to current evidence.

Topic Clustering of E-Cigarette Submissions Among Reddit Communities: A Network Perspective.

E-cigarette use in the United States has significantly grown in recent years. Widespread diffusion of e-cigarette content across social media communities may be contributing to this growth. In this study, we (1) explored topics related to e-cigarettes and vaping on Reddit and (2) examined the extent to which these topics clustered across distinct communities. We analyzed a total of N = 79,783 Reddit submissions posted between March 2017 and February 2018 that mentioned at least one e-cigarette or vaping keyword. We created a dictionary to classify submissions into seven different topics related to e-cigarettes and vaping. Submissions were also categorized into one of six mutually exclusive communities identified using subreddit meta-data. Our results indicate that e-cigarette and vaping content on Reddit is primarily about the buying and selling of e-cigarette products. Other common topics included how to build vaping devices, e-juice, and e-cigarette advice. Network correlation analyses found that the distribution of our seven identified topics varied significantly among general e-cigarette, drugs, and research/news subreddit communities. Findings from this study add to a growing literature investigating e-cigarettes and vaping on social media and also contribute to network-level theories by linking communities on Reddit to the diffusion of various depictions of e-cigarettes and vaping.

Adolescents' receptivity to E-cigarette harms messages delivered using text messaging.

INTRODUCTION: E-cigarette use among adolescents has dramatically risen since 2011, yet little research has tested e-cigarette harms messages among adolescents. We conducted a pretest-posttest pilot study to examine adolescents' receptivity to e-cigarette health harms messages delivered using text messaging. METHODS: N = 69 adolescents were enrolled in an 8-day pretest-posttest text messaging study. Participants completed a pretest survey on day one, were texted one of three e-cigarette health harms messages per day on days two through seven, and completed a posttest survey on day eight (88% retention). We assessed message ratings at posttest and knowledge, thoughts, and beliefs about e-cigarette harms at pretest and posttest. RESULTS: Adolescents rated the three messages favorably, with both the chemical and brain messages scoring higher than the nicotine message on fear arousal and perceived message effectiveness. More than one-third of adolescents showed the messages to others and talked to others about the messages. At posttest, knowledge about the harms of e-cigarettes, thinking about the risks of e-cigarettes, and perceived risks of e-cigarettes were all significantly higher compared to pretest (p < .05). Participants largely adhered to the text messaging protocol and found the study highly acceptable. CONCLUSIONS: This pilot study suggests that adolescents are receptive to e-cigarette health harms messages and that delivering such messages using text messaging is feasible and acceptable. Future research should systematically develop and test a broad set of e-cigarette health harms messages and examine their impact in a randomized controlled trial.

The Role of Knowledge and Risk Beliefs in Adolescent E-Cigarette Use: A Pilot Study.

The use of e-cigarettes and other vaping devices among adolescents is an urgent public health problem due to the concern about adolescent exposure to nicotine. This study examined: (1) adolescents’ knowledge and beliefs about e-cigarette risks; and (2) whether knowledge and risk beliefs were associated with e-cigarette use. N = 69 adolescents completed a cross-sectional survey about e-cigarette knowledge, attitudes (i.e., risk beliefs), and behavior (KAB). Nearly half (47%) of the sample reported ever using e-cigarettes. The majority of adolescents knew about many of the risks of e-cigarettes, with no differences between never- and ever-users. However, risk beliefs, such as worrying about health risks of using e-cigarettes, varied across groups. Compared to never-users, e-cigarette ever-users were significantly less likely to worry about e-cigarette health risks, less likely to think that e-cigarettes would cause them negative health consequences, and less likely to believe that e-cigarette use would lead to addiction. In a multivariable logistic regression, prior combustible cigarette use, mother’s education, and addiction risk beliefs about e-cigarettes emerged as significant predictors of adolescents’ e-cigarette use. This study reveals that while knowledge is not associated with adolescent e-cigarette use, risk beliefs do predict use.