The discrepancies between e-cigarette sales data and the prevalence of e-cigarette use from surveys highlight the challenges in tracking and understanding the use of new and emerging tobacco products. In a rapidly changing media environment, where successful and influential marketing campaigns can be conducted on social media at little cost, marketing expenditures alone may not fully capture the influence, reach and engagement of tobacco marketing.

Specific needs and ideal program focuses for cessation may vary across racial/ethnic groups, such that approaches tailored by race/ethnicity might be optimal. Traditional conceptualizations of cigarette addiction and the quitting process may need to be revised for racial/ethnic minority smokers.

BackgroundRapid increases in marketing of e-cigarettes coincide with growth in e-cigarette use in recent years; however, little is known about how e-cigarettes are marketed on social media platforms.MethodsKeywords were used to collect tweets related to e-cigarettes from the Twitter Firehose between 1 May 2012 and 30 June 2012. Tweets were coded for smoking cessation mentions, as well as health and safety mentions, and were classified as commercial or non-commercial (‘organic’) tweets using a combination of Naïve Bayes machine learning methods, keyword algorithms and human coding. Metadata associated with each tweet were used to examine the characteristics of accounts tweeting about e-cigarettes.Results73 672 tweets related to e-cigarettes were captured in the study period, 90% of which were classified as commercial tweets. Accounts tweeting commercial e-cigarette content were associated with lower Klout scores, a measure of influence. Commercial tweeting was largely driven by a small group of highly active accounts, and 94% of commercial tweets included links to websites, many of which sell or promote e-cigarettes. Approximately 10% of commercial and organic tweets mentioned smoking cessation, and 34% of commercial tweets included mentions of prices or discounts for e-cigarettes.ConclusionsTwitter appears to be an important marketing platform for e-cigarettes. Tweets related to e-cigarettes were overwhelmingly commercial, and a substantial proportion mentioned smoking cessation. E-cigarette marketing on Twitter may have public health implications. Continued surveillance of e-cigarette marketing on social media platforms is needed.

Abstract:The aim of our study was to explore reasons for starting and then stopping electronic cigarette (e-cigarette) use. Among a national sample of 3878 U.S. adults who reported ever trying e-cigarettes, the most common reasons for trying were curiosity (53%); because a friend or family member used, gave, or offered e-cigarettes (34%); and quitting or reducing smoking (30%). Nearly two-thirds (65%) of people who started using e-cigarettes later stopped using them. Discontinuation was more common among those whose main reason for trying was not goal-oriented (e.g., curiosity) than goal-oriented (e.g., quitting smoking) (81% vs. 45%, p < 0.001). The most common reasons for stopping e-cigarette use were that respondents were just experimenting (49%), using e-cigarettes did not feel like smoking cigarettes (15%), and users did not like the taste (14%). Our results suggest there are two categories of e-cigarette users: those who try for goal-oriented reasons and typically continue using and those who try for non-goal-oriented reasons and then typically stop using. Research should distinguish e-cigarette experimenters from motivated users whose decisions to discontinue relate to the utility or experience of use. Depending on whether e-cigarettes prove to be effective smoking cessation tools or OPEN ACCESSInt. J. Environ. Res. Public Health 2014, 11 10346 whether they deter cessation, public health programs may need distinct strategies to reach and influence different types of users.