Live, Love, Juul: User and Content Analysis of Twitter Posts about Juul

The past decade has seen rapid evolvement of ENDS (electronic nicotine delivery systems) commonly known as electronic cigarettes, e-cigarettes, or vaporizers. Although the use of tobacco products such as combustible cigarettes, cigars, snus, and pipes has decreased significantly in this same time period, there has been an uptick in the use of e-cigarettes particularly among adolescents (12-17 years old) and young adults (18-21 years old).[1-4] A 2015 report by the United States (US) Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA) on tobacco use estimates 2.39 million high school students and 620,000 middle school students have used e-cigarettes at least once during the past 30 days.[4] Since 2006, the estimated usage of e-cigarettes has soared from 3% to 20% among 6-12 graders.[5]

The surge in use of e-cigarettes (also referred as vaping) has created a major public health concern as it can create a new generation dependent on nicotine.[6] Like traditional cigarettes, e-cigarettes also contain toxins and nicotine, a powerful addictive chemical, harmful to adolescent brain development with negative consequences for their attention and learning abilities.[7,8] Although e-cigarettes are less toxic than traditional combustible cigarettes, they could facilitate transition to other smoking products and illicit substances. One study carried out among 808 students of 3 public schools in Connecticut indicates that e-cigarettes use was associated with combustible cigarette use.[9] Similarly, other studies found substantial evidence that e-cigarette use increases the risk of transitioning to the habitual use of combustible cigarettes.[3,10-12] Moreover, studies also specify that increased exposure to e-cigarettes also could facilitate transition from e-cigarettes to consuming illicit substances such as marijuana.[13,14]

Whereas smoking combustible cigarettes among youth has declined steadily during the last decade, use of e-cigarettes has increased.[3,15] Despite numerous efforts to regulate the sales and promotion of e-cigarettes, many adolescents and young adults perceive vaping as a healthier and safer substitute to combustible cigarettes.[16-18] Moreover, these devices have extended traction due to their perceived socially desirable characteristics that helps them in avoiding the “smoker” tag. For instance, perception of being cool, supporting one’s social image, and peer validation are some salient social attributes linked to the popularity of e-cigarettes.[12,14,16,19] Studies also suggest that marketed wellness (ie, less harmful and less addictive), easy accessibility, price, and an assortment of flavors further make e-cigarettes more appealing to adolescents and young adults.[2,3,12,18,20]

Juul, a product developed by Pax Labs and launched in 2015, has provided a strong boost to the vaping industry. Juul is a closed-system vaping device that has become the largest e-cigarette brand in the US capturing approximately 55% of the e-cigarette market.[21] The company actively markets Juul as a smoking cessation device and harm reduction alternative through messages, such as: “Juul is an alternative to all the distasteful elements of smoking” and “Our mission is to eliminate cigarettes by offering existing adult smokers a true alternative.”[22] Despite these targeted promotions to adult smokers, measures such as age verification for online ordering (over 21 years), and awareness and prevention campaigns by the parent company, Juul’s popularity has increase rapidly among adolescents and young adults. In addition to Juul’s novelty and design aesthetics, its ease of use, portability, marginal smell, and ease of concealment from parents and teachers has been attributed for this surge.[23,24] For instance, its size (L= 9.48 cm, W= 1.51 cm) makes it slightly larger than a combustible cigarette and easy to hide. The device looks like a USB flash drive and can be recharged through a USB port. It is virtually smokeless and the smell of its vapor can be mistaken for fruits or candies. The disposable nicotine pods (5% by weight), are almost the size of a thumb and available in different flavors including mango, mint, cucumber, and fruit medley. A single Juul pod contains about the same amount of nicotine as supplied by a pack of 20 combustible cigarettes.[25] The high dose of nicotine in a single pod of Juul can have negative consequences for adolescents’ attention and learn- ing abilities.[7,8] Moreover, sleek design of the device itself and the disposable pods being available in a variety of fruity favors entice minors toward its use. Flavored nicotine in Juul pods is not only attractive, but also can mislead users about the harmfulness of the product.[26]

Traditional media, campus newspapers, school and college websites/social media accounts, and more recently, scholarly work have initiated stressing the penetration and consequences of underage Juul use.[24,27,28] An active discussion on a number of social media platforms also highlights the popularity of Juul among school and college students. For instance, Twitter is used by students to discuss different places for using Juul at school including class rooms, bathrooms, and libraries.[28] Anecdotal evidence further suggests that it is easy for these groups to access Juul through peers as well as purchase the device and accessories through a breading underground marketplace on social platforms such as Reddit.[29] The popularity and widespread adoption of Juul has been labeled as alarming and a catastrophic public health crisis as it holds a strong potential of creating a new generation of smokers addicted to nicotine.[30] To curb Juul use among students, a principal of an Annapolis, Maryland high school ordered removal of bathroom doors. Likewise, a New Jersey School System installed detectors to alert school administration about Juul use (as well as other forms of e-cigarettes) in school. Meanwhile, a school district in eastern Pennsylvania has banned USB flash drives to effect control of Juul use by minors.[30] The urgency around use of Juul by teens has reached such proportions that the parent company is purported to be scrutinizing the use of Bluetooth technology to combat use among teenagers by regularly verifying age as well as automatically shutting down the devices by geo-fencing around schools.[31]

Twitter is one of the leading microblogging social media platforms where users can share personal opinions or information appended by a photo, video, or a URL. In addition to other popular social media platforms such as Facebook and Instagram, Twitter has been used for tobacco-related conversations, not only by the public, but also by the tobacco industry (eg, @RAI_News, @the_tma), public health agencies (eg, @CDCTobaccoFree, @FDATobacco), smoking advocacy groups (@ CASAAmedia, @AVABoard) and anti-tobacco campaigners (@TobaccoPrev, @truthinitiative).[32] As a rich data source, Twitter also has been used by researchers for investigating use and perceptions of tobacco-related products in the general public and among vulnerable population such as adolescents, young adults, African Americans, and Hispanics.[16,23,33,34] Furthermore, Twitter has been considered an important data source for addressing emerging issues and products in public health surveillance or epidemiological research.[16] Social media platforms provide novel data streams that can support public health surveillance, survey development, educational campaigns, and policymaking.[16] Tobacco-related research has started to leverage Web-based data streams (including social media platforms) to bridge the gap in tobacco-related research – use and trends in e-cigarettes and tobacco-control campaigns, for example.[19,35-37]

Presently, the popularity of a given product or service among youth is increasingly tied to social media use as new products and services are actively followed, discussed, and reviewed on platforms such as Facebook, Instagram, and Twitter. Due to the high acceptance and acclaim of e-cigarettes, adolescents and young adults, enthusiastically research them on various social media platforms where they familiarize themselves with new flavors, devices, and different hacks and tricks.[17] As Juul adoption has increased, data from social media platforms can be a potential source to gather the societal as well as the environmental context in which the device is being used, perceived, and debated by various entities. Despite a strong prevalence of Juul among youth, highlights in broadcast media, and alarming concerns among school authorities, parents, and the public health community, formal research documenting relevant conversations and communication to improve understanding of the shared perceptions and attitudes about Juul has been scarce. Furthermore, the current surveillance systems for tobacco use that primarily rely on traditional methods fail to capture the rapid developments of emerging products such as Juul.[17] In addition, many young adults and adolescent e-cigarette users do not identify themselves as being smokers.[38] Considering these challenges in tracking and monitoring the use of emerging smoking substitutes and accessories marketed by the tobacco industry, the focus of the present study is to examine and understand the snapshots of dialogues on Twitter by different entities surrounding Juul. The key objective of our analysis is to identify key user groups and conversational patterns about Juul by conducting a content analysis of relevant tweets. Findings from this study can inform the assessment and design of control and prevention campaigns for use of tobacco alternatives and the development of future regulatory policies. Furthermore, findings from the current study pose several significant implications for research investigations associated with emergent tobacco industry-inspired commodities, and the public health community interests in tobacco use surveillance, particularly among minors and young adults.

Live, Love, Juul: User and Content Analysis of Twitter Posts about Juul

Aqdas Malik
Yisheng Li
Habib Karbasian
Juho Hamari
Aditya Johri

Citation: Malik, A., Li, Y., Karbasian, H., Hamari, J., & Johri, A. (2019). Live, love, Juul: User and content analysis of Twitter posts about Juul. American journal of health behavior, 43(2), 326-336. DOI: 10.5993/AJHB.43.2.9

Please see the paper for full details: 
Journal
ResearchGate

Abstract

In this study, we identified patterns of communication around Juul use and users on Twitter. Methods: Public tweets were collected from April 27, 2018 until June 27, 2018. We categorized 1008 randomly selected tweets on 4 dimensions: user type, sentiment, genre, and theme. Results: Most tweets were through personal accounts followed by ones of the tobacco industry. Participation by anti-tobacco campaigners, educational, and governmental entities was limited. Posts were mostly about first-hand use, use intentions, and personal opinions. Tweets advocating Juul were most common; meanwhile a handful of tweets discouraged Juul use. Young women, young men, and the tobacco industry expressed positive sentiments about Juul. Conclusions: Twitter data are a rich source of public communication to complement surveillance of emerging tobacco products. Youth actively and positively communicate about Juul on Twitter. Educational content and strategies must be examined for curtailing dissemination of positive sentiments and advocacy that normalize and promote Juul use among youth and non-smokers. We observed limited evidence supporting a claim for Juul to be a smoking cessation adjunct.

References

[1] Choi K, Grana R, Bernat D. Electronic nicotine delivery systems and acceptability of adult cigarette smoking among Florida youth: renormalization of smoking? J Adolesc Health. 2017;60(5):592-598.
[2] Harrell MB, Weaver SR, Loukas A, et al. Flavored e-cigarette use: characterizing youth, young adult, and adult users. Prev Med Rep. 2017;5:33-40.
[3] Modesto-Lowe V, Alvarado C.  E-cigs… are they cool? talking to teens about e-cigarettes. Clin Pediatr. 2017;56(10):947-952.
[4]Singh T, Arrazola RA, Corey CG, et al. Tobacco use among middle and high school students – United States. MMWR Morb Mortal Wkly Rep. 2016;65(14):361-367.
[5] Hammig B, Daniel-Dobbs P, Blunt-Vinti H. Electronic cigarette initiation among minority youth in the United States. Am J Drug Alcohol Abuse. 2017;43(3):306-310.
[6] Grana RA, Ling PM. “Smoking revolution”: a content analysis of electronic cigarette retail websites. Am J Prev Med. 2014;46(4):395-403.
[7] England LJ, Bunnell RE, Pechacek TF, et al. Nicotine and the developing human: a neglected element in the electronic cigarette debate. Am J Prev Med. 2015;49(2):286- 293.
[8] US Department of Health and Human Services (USD- HHS). E-Cigarette Use among Youth and Young Adults. A Report of the Surgeon General. Atlanta, GA: USDHHS; 2016. Available at: https://e-cigarettes.surgeongeneral. gov/documents/2016_SGR_Full_Report_non-508.pdf. Accessed October 29, 2018.[9] Bold KW, Kong G, Camenga DR, et al. Trajectories of e-cigarette and conventional cigarette use among youth. Pediatrics. 2017;141(1):e20171832.
[10] Cardenas VM, Evans VL, Balamurugan A, et al. Use of electronic nicotine delivery systems and recent initiation of smoking among US youth. Int J Public Health. 2016;61(2):237-241.
[11] National Academies of Sciences, Engineering, and Medicine. Public Health Consequences of E-cigarettes. National Academies Press 2018. Available at: https://www.nap. edu/catalog/24952/public-health-consequences-of-e-cigarettes. Accessed October 29, 2018.
[12] Schneider S, Diehl K. Vaping as a catalyst for smoking? An initial model on the initiation of electronic cigarette use and the transition to tobacco smoking among adolescents. Nicotine Tob Res. 2016;18(5):647-653.
[13] Giroud C, de Cesare M, Berthet A, et al. E-cigarettes: a review of new trends in cannabis use. Int J Environ Res Public Health. 2015;12(8):9988-10008.
[14] Unger JB, Soto DW, Leventhal A. E-cigarette use and subsequent cigarette and marijuana use among Hispanic young adults. Drug Alcohol Depend. 2016;163:261-264.
[15] McMillen RC, Gottlieb MA, Shaefer RMW, et al. Trends in electronic cigarette use among US adults: use is increasing in both smokers and nonsmokers. Nicotine Tob Res. 2015;17(10):1195-1202.
[16] Ayers JW, Leas EC, Allem JP, et al. Why do people use electronic nicotine delivery systems (electronic cigarettes)? A content analysis of Twitter, 2012-2015. PLoS One. 2017;12(3):e170702.
[17] Hilton S, Weishaar H, Sweeting H, et al. E-cigarettes, a safer alternative for teenagers? A UK focus group study of teenagers’ views. BMJ Open. 2016;6(11):e013271.
[18] Cheney MK, Gowin M, Wann TF. Electronic cigarette use in straight-to-work young adults. Am J Health Behav. 2016;40(2):268-279.
[19] Romito LM, Hurwich RA, Eckert GJ. A snapshot of the depiction of electronic cigarettes in YouTube videos. Am J Health Behav. 2015;39(6):823-831.
[20] de Andrade M, Angus K, Hastings G. Teenage perceptions of electronic cigarettes in Scottish tobacco-education school interventions: co-production and innovative engagement through a pop-up radio project. Perspect Public Health. 2016;136(5):288-293.
[21] Weisman S. What’s the hype? Juul electronic cigarettes popularity with youth & young adults. Public Health Law Center. 2018. Available at: http://www.publi- chealthlawcenter.org/sites/default/…/Juul-Webinar-Slides- Apr262018.pdf. Accessed October 15, 2018.
[22] JUUL (@JUULvapor) | Twitter. Available at: https://twitter.com/JUULvapor. Accessed October 15, 2018.
[23] Huang J, Duan Z, Kwok J, et al. Vaping versus JUULing: how the extraordinary growth and marketing of JUUL transformed the US retail e-cigarette market. Tob Control. 2018 May 31. pii: tobaccocontrol-2018-054382. doi: 10.1136/tobaccocontrol-2018-054382.
[24] Willett JG, Bennett M, Hair EC, et al. Recognition, use and perceptions of Juul among youth and young adults. Tob Control. 2019;28(1):115-116.
[25] JUULpods and E-Liquid FAQs – JUUL Support. JUUL- pod Basics. Available at: https://support.juul.com/home/ learn/faqs/juulpod-basics. Accessed October 26, 2018.
[26] Truth Initiative. Juul e-cigarette craze highlights the dangers of flavored tobacco. 2018. Available at: https://truthi- nitiative.org/news/juul-e-cigarette-craze-highlights-why- flavored-tobacco-products-are-so-dangerous. Accessed October 15, 2018.
[27] Kavuluru R, Han S, Hahn EJ. On the popularity of the USB flash drive-shaped electronic cigarette Juul. Tob Control. 2019;28(1):110-112.
[28] Allem J-P, Dharmapuri L, Unger JB, Cruz TB. Characterizing JUUL-related posts on Twitter. Drug Alcohol Depend. 2018;190:1-5.
[29] Ross B. Juul Vaporizers: nicotine alternative hits campus. The Daily Evergreen. 2018. Available at: https://dailyever- green.com/24025/mint/juul-vaporizers-nicotine-alternative-hits-campus/. Accessed October 15, 2018.
[30] Bui L. Juuling: If you don’t know what it is, ask your kids. Washington Post. 2018. Available at: https://www.wash- ingtonpost.com/local/public-safety/juuling-if-you-dont- know-what-it-is-ask-your-kids/2018/05/09/37e2f026- 4d65-11e8-84a0-458a1aa9ac0a_story.html?utm_ term=.0fc2a53b4ed5. Accessed October 25, 2018.
[31] Locklear M. Juul wants to use Bluetooth e-cigs to lock out teen smokers. Engadget. Available at: https://www. engadget.com/2018/08/02/juul-bluetooth-e-cigs-lock- out-teen-smokers/. Published 2018. Accessed October 15, 2018.
[32] Allem J-P, Escobedo P, Chu K-H, et al. Campaigns and counter campaigns: reactions on Twitter to e-cigarette education. Tob Control. 2017;26(2):226-229.
[33] Cole-Lewis H, Pugatch J, Sanders A, et al. Social listening: a content analysis of e-cigarette discussions on Twitter. J Med Internet Res. 2015;17(10):e243.
[34] Krauss MJ, Sowles SJ, Moreno M, et al. Hookah-related twitter chatter: a content analysis. Prev Chronic Dis. 2015;12:e121.
[35] Chu K-H, Allem J-P, Cruz TB, Unger JB. Vaping on Insta- gram: cloud chasing, hand checks and product placement. Tob Control. 2017;26(5):575-578.
[36] Allem J-P, Chu K-H, Cruz TB, Unger JB. Waterpipe promotion and use on Instagram:# hookah. Nicotine Tob Res. 2017;19(10):1248-1252.
[37]Ayers JW, Althouse BM, Allem J-P, et al. Revisiting the rise of electronic nicotine delivery systems using search query surveillance. Am J Prev Med. 2016;50(6):e173-e181.
[38] Agaku I, Odani S, Vardavas C, Neff L. Self-Identified tobacco use and harm perceptions among US youth. Pediatrics. 2018;141(4):e20173523.