Background The COVID-19 outbreak was designated a global pandemic on March 11, 2020. The relationship between vaping and contracting COVID-19 is unclear, and information on the internet is conflicting. There is some scientific evidence that vaping cannabidiol (CBD), an active ingredient in cannabis that is obtained from the hemp plant, or other substances is associated with more severe manifestations of COVID-19. However, there is also inaccurate information that vaping can aid COVID-19 treatment, as well as expert opinion that CBD, possibly administered through vaping, can mitigate COVID-19 symptoms. Thus, it is necessary to study the spread of inaccurate information to better understand how to promote scientific knowledge and curb inaccurate information, which is critical to the health of vapers. Inaccurate information about vaping and COVID-19 may affect COVID-19 treatment outcomes. Objective Using structural topic modeling, we aimed to map temporal trends in the web-based vaping narrative (a large data set comprising web-based vaping chatter from several sources) to indicate how the narrative changed from before to during the COVID-19 pandemic. Methods We obtained data using a textual query that scanned a data pool of approximately 200,000 different domains (4,027,172 documents and 361,100,284 words) such as public internet forums, blogs, and social media, from August 1, 2019, to April 21, 2020. We then used structural topic modeling to understand changes in word prevalence and semantic structures within topics around vaping before and after December 31, 2019, when COVID-19 was reported to the World Health Organization. Results Broadly, the web-based vaping narrative can be organized into the following groups or archetypes: harms from vaping; Vaping Regulation; Vaping as Harm Reduction or Treatment; and Vaping Lifestyle. Three archetypes were observed prior to the emergence of COVID-19; however, four archetypes were identified post–COVID-19 (Vaping as Harm Reduction or Treatment was the additional archetype). A topic related to CBD product preference emerged after COVID-19 was first reported, which may be related to the use of CBD by vapers as a COVID-19 treatment. Conclusions Our main finding is the emergence of a vape-administered CBD treatment narrative around COVID-19 when comparing the web-based vaping narratives before and during the COVID-19 pandemic. These results are key to understanding how vapers respond to inaccurate information about COVID-19, optimizing treatment of vapers who contract COVID-19, and possibly minimizing instances of inaccurate information. The findings have implications for the management of COVID-19 among vapers and the monitoring of web-based content pertinent to tobacco to develop targeted interventions to manage COVID-19 among vapers.

Objective News coverage around vaping-related events may have furthered misconceptions regarding the relative harms of vapes. Such information may influence the decisions of individuals who smoke, around switching to vaping, potentially affecting the overall tobacco mortality burden. Thus, it is prudent to study how news events (e.g., 2019 vaping illness epidemic) are associated with vape sales in the United States, to possibly reduce the tobacco mortality burden. Methods We used weekly retail sales data for e-cigarettes (30 December 2018 - 28 December 2019) from the US retail scanner data compiled by the Nielsen Company. We used an interrupted time series design with segmented regression analysis to determine immediate and longer-term impacts of individual news events (e.g. Trump administration’s planned ban on some flavored vaping products) on vape sales, controlling for pre-existing trends. Results Unexpectedly, we noted a statistically significant positive relationship between vape sales and the CDC announcing an investigation into vaping-related illnesses (Change: 6.59%, Estimate: 0.066; 95% CI: 0.036, 0.092; P < 0.001). We also observed a similar positive association between vape sales and the CDC’s announcement on the link between Vitamin E acetate and EVALI (Change: 2.93%, Estimate: 0.029; 95% CI: 0.003, 0.055; P < 0.05). There was a steep decline in sales after these events. Conclusions News events may be associated with US vape sales. Findings have implications for the management of risk perceptions around vaping to improve health outcomes of tobacco users. Information-based policy instruments can be applied to balance the effects of news events that may influence vape sales.

BACKGROUND The spread of the coronavirus disease (Covid-19) is becoming unstoppable and has become a global pandemic as of March 11 2020. The relationship between vaping and contracting Covid-19 is unclear, with conflicting information online. There is some scientific evidence that vaping, cannabidiol (CBD - an active ingredient in cannabis from the hemp plant) or otherwise, may be associated with more severe manifestations of Covid-19. However, there is also inaccurate information that vaping can aid Covid-19 treatment, and expert opinion that CBD, possibly administered through vaping, can mitigate Covid-19 symptoms. Thus, we need to study the spread of inaccurate information to better understand how to promote scientific knowledge and curb inaccurate information, critical to vapers' health. Inaccurate information about vaping and Covid-19 may affect Covid-19 treatment outcomes. OBJECTIVE Using the novel computational technique of structural topic modelling, we mapped temporal trends in the online vaping narrative (a large dataset comprising online vaping chatter from several sources) to indicate how the narrative changed before versus during Covid-19. METHODS We obtained data using a textual query that scanned a data pool of approximately 200000 (5230094 documents and 468961409 words) different domains such as public online forums, blogs and social media from August 1 2019 - April 21 2020. We then used structural topic modelling to understand changes in word prevalence and semantic structures within topics around vaping before and after December 31 2019, when Covid-19 was reported to the World Health Organization (WHO). RESULTS Broadly, the online vaping narrative could be broadly organized into the following groups or archetypes: 1) Harms from vaping; 2) Vaping regulation; 3) Vaping as harm reduction/treatment; 4) Vaping lifestyle. The discourse around CBD, likely administered through vaping, became more prevalent as the pandemic progressed. The emergence of the CBD product preference topic post-Covid-19 report to the World Health Organization may be related to vapers using CBD as a Covid-19 treatment. CONCLUSIONS Our main finding is the emergence of a vape-administered CBD treatment narrative around Covid-19, when comparing the pre-Covid-19 versus during Covid-19 online vaping narrative. The strength of this study is our use of innovative computational methods to explore the content of the narrative and how it is affected by Covid-19. Such outcome measurement is key to understanding how vapers respond to inaccurate information about Covid-19, allowing for optimized treatment of vapers who contract Covid-19, and possibly minimizing instances of inaccurate information. Findings have implications for the management of Covid-19 among vapers and monitoring of online content pertinent to tobacco, to develop targeted interventions to manage Covid-19 among vapers.

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Weak instruments present a major setback to empirical work. This paper introduces an estimator that admits weak, uncorrelated, or mean-independent instruments that are non-independent of endogenous covariates. Relative to conventional instrumental variable methods, the proposed estimator weakens the relevance condition considerably without imposing a stronger exclusion restriction. Identification mainly rests on (1) a weak conditional median exclusion restriction imposed on pairwise differences in disturbances and (2) nonindependence between covariates and instruments. Under mild conditions, the estimator is consistent and asymptotically normal. Monte Carlo experiments showcase an excellent performance of the estimator, and two empirical examples illustrate its practical utility.