@Article{info:doi/10.2196/26335,
author="Sidani, Jaime E
and Hoffman, Beth
and Colditz, Jason B
and Wolynn, Riley
and Hsiao, Lily
and Chu, Kar-Hai
and Rose, Jason J
and Shensa, Ariel
and Davis, Esa
and Primack, Brian",
title="Discussions and Misinformation About Electronic Nicotine Delivery Systems and COVID-19: Qualitative Analysis of Twitter Content",
journal="JMIR Form Res",
year="2022",
month="Apr",
day="13",
volume="6",
number="4",
pages="e26335",
keywords="COVID-19; coronavirus; e-cigarette; electronic nicotine delivery systems; Twitter; social media; misinformation; discussion; public health; communication; concern; severity; conspiracy",
abstract="Background: Misinformation and conspiracy theories related to COVID-19 and electronic nicotine delivery systems (ENDS) are increasing. Some of this may stem from early reports suggesting a lower risk of severe COVID-19 in nicotine users. Additionally, a common conspiracy is that the e-cigarette or vaping product use--associated lung injury (EVALI) outbreak of 2019 was actually an early presentation of COVID-19. This may have important public health ramifications for both COVID-19 control and ENDS use. Objective: Twitter is an ideal tool for analyzing real-time public discussions related to both ENDS and COVID-19. This study seeks to collect and classify Twitter messages (``tweets'') related to ENDS and COVID-19 to inform public health messaging. Methods: Approximately 2.1 million tweets matching ENDS-related keywords were collected from March 1, 2020, through June 30, 2020, and were then filtered for COVID-19--related keywords, resulting in 67,321 original tweets. A 5{\%} (n=3366) subsample was obtained for human coding using a systematically developed codebook. Tweets were coded for relevance to the topic and four overarching categories. Results: A total of 1930 (57.3{\%}) tweets were coded as relevant to the research topic. Half (n=1008, 52.2{\%}) of these discussed a perceived association between ENDS use and COVID-19 susceptibility or severity, with 42.4{\%} (n=818) suggesting that ENDS use is associated with worse COVID-19 symptoms. One-quarter (n=479, 24.8{\%}) of tweets discussed the perceived similarity/dissimilarity of COVID-19 and EVALI, and 13.8{\%} (n=266) discussed ENDS use behavior. Misinformation and conspiracy theories were present throughout all coding categories. Conclusions: Discussions about ENDS use and COVID-19 on Twitter frequently highlight concerns about the susceptibility and severity of COVID-19 for ENDS users; however, many contain misinformation and conspiracy theories. Public health messaging should capitalize on these concerns and amplify accurate Twitter messaging. ",
issn="2561-326X",
doi="10.2196/26335",
url="https://formative.jmir.org/2022/4/e26335",
url="https://doi.org/10.2196/26335",
url="http://www.ncbi.nlm.nih.gov/pubmed/35311684"
}