To Tweet or Not to Tweet: Tweets About Tobacco Regulation can Help Disseminate Anti-regulatory Messages

Abstract

Introduction Twitter enables public organizations to engage the public in health policy discourse. However, documented hostility towards tobacco control proposals on Twitter suggests that a closer examination of the nature of interaction with such content is warranted. Methods We scraped tweets from government bodies with tobacco control interests between July and November of 2021 (N=3,889), two months before and after the Food and Drug Administration’s (FDA) Premarket Tobacco Authorization Act’s (PMTA) September deadline. PMTA is a review process for authorizing the sale of new and existing e-cigarette or vaping products. Tweets related to PMTA were identified (n=52) using a keyword filter. A content analysis of quote tweets and replies examined the amplification of pro and anti-policy sentiment via likes and retweets. Results Replies were overwhelmingly anti-policy (96.7%). Moreover, the amplification of these replies, including 83.3% of likes and 65.6% of retweets, amplified anti-policy replies. Quote tweets, which allow users to add their own commentary to an existing tweet, were 77.9% (n=120) anti-policy, receiving 87.7% of likes (n=1708) and 86.2% of retweets (n=726) compared to pro-policy quote tweets (n=240 likes and n=116 retweets). Regression analyses showed a significantly greater amplification of anti-policy content. Conclusions Communicating about tobacco policy on Twitter carries risks. Anti-policy advocates can weaponize quote tweets for easy construction of messages designed in accordance with evidence-based guidelines for conferring resistance to persuasion. Future research should examine whether public health organizations can adapt this strategy to counter anti-regulatory advocates on Twitter. IMPLICATIONS The primary implications of this research are that communication about tobacco policy on Twitter should be part of a broader public engagement strategy with quantifiable metrics of success. The information environment on Twitter is demonstrably hostile to pro-tobacco regulatory policy positions. As a result, efforts to engage on the platform by regulatory institutions like the FDA can inadvertently provide materials that are easily leveraged as effective counter-messaging. Moreover, this counter-messaging can disseminate more broadly than the original message.

Social Network Analysis of e-Cigarette–Related Social Media Influencers on Twitter/X: Observational Study

“…Besides posting provaping messages, vaping advocates also posted messages advocating against tobacco regulatory policies, as shown in the major topics discussed by the e-cigarette influencers on Twitter/X. The vaping advocates directly contribute highly negative comments to FDA communication efforts, such as the FDA flavor enforcement policy and the proposed rules on menthol cigarettes [ 30 , 54 - 57 ]. These antiregulatory posts on social media might have a negative effect on the effectiveness of the FDA regulatory efforts.…”