Why do people use electronic nicotine delivery systems (electronic cigarettes)? A content analysis of Twitter, 2012-2015

Abstract

The reasons for using electronic nicotine delivery systems (ENDS) are poorly understood and are primarily documented by expensive cross-sectional surveys that use preconceived close-ended response options rather than allowing respondents to use their own words. We passively identify the reasons for using ENDS longitudinally from a content analysis of public postings on Twitter. All English language public tweets including several ENDS terms (e.g., “e-cigarette” or “vape”) were captured from the Twitter data stream during 2012 and 2015. After excluding spam, advertisements, and retweets, posts indicating a rationale for vaping were retained. The specific reasons for vaping were then inferred based on a supervised content analysis using annotators from Amazon’s Mechanical Turk. During 2012 quitting combustibles was the most cited reason for using ENDS with 43% (95%CI 39–48) of all reason-related tweets cited quitting combustibles, e.g., “I couldn’t quit till I tried ecigs,” eclipsing the second most cited reason by more than double. Other frequently cited reasons in 2012 included ENDS’s social image (21%; 95%CI 18–25), use indoors (14%; 95%CI 11–17), flavors (14%; 95%CI 11–17), safety relative to combustibles (9%; 95%CI 7–11), cost (3%; 95%CI 2–5) and favorable odor (2%; 95%CI 1–3). By 2015 the reasons for using ENDS cited on Twitter had shifted. Both quitting combustibles and use indoors significantly declined in mentions to 29% (95%CI 24–33) and 12% (95%CI 9–16), respectively. At the same time, social image increased to 37% (95%CI 32–43) and lack of odor increased to 5% (95%CI 2–5), the former leading all cited reasons in 2015. Our data suggest the reasons people vape are shifting away from cessation and toward social image. The data also show how the ENDS market is responsive to a changing policy landscape. For instance, smoking indoors was less frequently cited in 2015 as indoor smoking restrictions became more common. Because the data and analytic approach are scalable, adoption of our strategies in the field can inform follow-up survey-based surveillance (so the right questions are asked), interventions, and policies for ENDS.

E-cigarettes and Tobacco Exposure Biomarkers among American Indian Smokers

“…Among US smokers, e-cigarettes are used most often to reduce or quit smoking 3,4 and, historically, smoking cessation patterns and motivations vary by age, sex, and income 38–41 including among AIs/ANs. 42–45 Some studies show associations between electronic cigarette use and sex 9,10 but not all.…”

“…1,2 Many individuals use e-cigarettes to help them reduce or quit smoking, 3,4 but the effectiveness of e-cigarettes as smoking cessation aids remains unproven 5 and these products are not approved by the FDA for smoking cessation. 6 American Indians and Alaska Natives (AIs/ANs) have the highest prevalence of cigarette smoking nationwide; 7 yet, few studies report or evaluate e-cigarette use among AIs/ANs.…”

Internet-based Advertising Claims and Consumer Reasons for Using Electronic Cigarettes by Device Type in the US

“…Other media-based work suggests that leading consumer reasons for using e-cigarettes has shifted from health and cessation reasons. 15,23 It is possible that the decline in current e-cigarette Internet searches and Tweets pertaining to health and cessation reflect the accumulation of a critical mass of information about these topics, and a shift to consumer actions to acquire the product and reflect on other benefits.…”

“…16–22 Work utilizing Web data suggests a shift in consumer reasons for using e-cigarettes from cessation and indoor use toward external benefits such as social image. 23 Given important differences between open- and closed-system devices, understanding variability in consumer reasons for using these products also may inform regulation. This paper compares Internet-based advertising claims of closed- versus open-system products, and evaluates US consumers’ reasons for using closed- versus open-system e-cigarettes.…”

High-resolution Temporal Representations of Alcohol and Tobacco Behaviors from Social Media Data

“…Further, many alcohol and tobacco behaviors are both public and social. As such, they will often be shared and discussed on social media (illustrated by numerous other studies examining topics and locations of social media discussion about tobacco and alcohol [7, 20, 50]). Simultaneously, tobacco use and addiction mostly begin during youth and young adulthood [78] and alcohol use is associated with the top four leading causes of morbidity and mortality in adolescents [33] making them significant health risks for this age group.…”