JMIR Publications

ABSTRACT

Background:

There exists an alarming amount of misinformation and conspiracy theories related to COVID-19 and electronic nicotine delivery systems (ENDS). 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 COVID19 disease. This may have severe public health ramifications for both COVID-19 control and electronic delivery systems (ENDS) use.

Objective:

Twitter is an ideal tool for analyzing real-time public discussions related to both ENDS and COVID-19. This study sought 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 3/1/2020 through 6/30/2020 and were then filtered for COVID-19-related keywords, resulting in 67,321 original tweets. A 5% subsample (n=3,366) 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 1,930 (57.3%) tweets were coded as relevant to the research topic. Half (52.2%) of these discussed an association between ENDS use and COVID-19 susceptibility or severity, with 42.4% suggesting that ENDS use is associated with worse COVID-19 symptoms. One-quarter (24.8%) of tweets discussed the similarity/dissimilarity of COVID-19 and EVALI, and 13.8% 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.