TitleDiscussions and Misinformation About Electronic Nicotine Delivery Systems and COVID-19: Qualitative Analysis of Twitter Content.
Publication TypeJournal Article
Year of Publication2022
AuthorsSidani, JE, Hoffman, B, Colditz, JB, Wolynn, R, Hsiao, L, Chu, K-H, Rose, JJ, Shensa, A, Davis, E, Primack, BA
JournalJMIR Form Res
Date Published04/2022

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.

Alternate JournalJMIR Form Res
PubMed ID35311684
PubMed Central IDPMC9009382
Grant ListK08 HL136857 / HL / NHLBI NIH HHS / United States
K12 DA050607 / DA / NIDA NIH HHS / United States
R01 CA225773 / CA / NCI NIH HHS / United States