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.

Public health organizations are increasingly turning to social media as a channel for health campaign dissemination, as these platforms can provide access to “hidden” or at-risk audiences such as populations of color and youth. However, few studies systematically assess the effects of such campaigns in a competitive communication environment characterized by an influx of sophisticated tobacco product marketing. The objective of the current study is to investigate how content and source features of Twitter messages about truth® campaigns influence their popularity, support, and reach. Keyword rules were used to collect tweets related to each of the six campaigns from the Twitter Firehose posted between August 2014 and June 2016. Data were analyzed using a combination of supervised and unsupervised machine learning, keyword algorithms, and human coding. Tweets were categorized by source type (direct or truth®-owned social influencer; non-influencer). Tweet content was coded and classified for valence and campaign references (branded vs. non-branded or organic content). Message reach was calculated by source type and message type. Keyword filters captured 308,216 tweets posted by 225,912 Twitter users. Findings revealed that campaigns that utilized social influencers as message sources generated more campaign-branded and sharable content (e.g., campaign hashtags) and greater volume of tweets per day and reach per day. Influential users posted fewer organic messages and more branded/sharable content, generating greater reach compared to non-influencers. Oppositional messages decreased over time. Harnessing cultural elements endemic to social media, such as popular content creators (influencers) and messages (memes), is a promising strategy for improving health campaign interest and engagement.

BackgroundTobacco product advertising has been shown to reach youth and promote initiation. This study assessed trends in e-cigarette advertising expenditures in the USA during 2014–2018, overall and by manufacturer and media type.MethodsData came from Kantar Media, which provides information on US advertising expenditures, including for e-cigarettes. Advertising expenditures were estimated as the dollar amount spent by e-cigarette companies to purchase advertising space in print, television, Internet, radio and outdoors. Dollar amounts were adjusted to 2017 dollars. Trends in e-cigarette advertising expenditures during 2014–2018 were analysed using Joinpoint regression overall, by media type, and by manufacturers based on 2017–2018 national sales.ResultsTotal e-cigarette advertising expenditures in print, radio, television, Internet and outdoors decreased substantially from US$133 million in 2014 to US$48 million in 2017, followed by an increase to US$110 million in 2018. By media type, expenditures were highest for print advertising, irrespective of year. By manufacturer, Altria had the highest e-cigarette advertising expenditures, totalling over US$134 million during 2014–2018. Imperial Tobacco had the second highest, totalling over US$85 million during 2014–2018, while JUUL Labs had the highest single-year expenditures, spending over US$73 million in 2018 alone.ConclusionsE-cigarette advertising expenditures have been volatile in the USA, with declines in traditional advertising venues during 2014–2017 that may reflect a shift towards social media. However, an increase occurred in 2018 that is likely reflective of advertising by newer manufacturers. Continued monitoring of e-cigarette advertising is important to inform tobacco control strategies.