JMIR Publications

ABSTRACT

Background:

Misinformation online about e-cigarette harms may increase smokers’ misperceptions of e-cigarettes. There is limited research on smokers’ engagement with misinformation about e-cigarettes on social media.

Objective:

This study assessed smokers’ likelihood to engage with—defined as replying, retweeting, liking, and sharing—tweets that contain misinformation and uncertainty about the harms of e-cigarettes.

Methods:

We conducted an online randomized controlled experiment among 2400 UK and US adult smokers who did not vape in the past 30 days. Participants were randomly assigned to view four tweets in one of four conditions: 1) E-cigarettes are as harmful or more harmful than smoking, 2) E-cigarettes are completely harmless, 3) Uncertainty about e-cigarette harms, or 4) Control (physical activity). The outcome measure was participants’ likelihood of engagement with tweets, comprising the sum of whether they would reply, retweet, like, and share each tweet. We fitted Poisson regression models to predict the likelihood of engagement with tweets among 974 Twitter users and 1287 non-Twitter social media users, adjusting for covariates and stratified by UK and US participants.

Results:

Among Twitter users, participants were more likely to engage with tweets in Condition 1 (e-cigarettes are as harmful or more harmful than smoking) than Condition 2 (e-cigarettes are completely harmless). Among other social media users, participants were more likely to likely to engage with tweets in Condition 1 than Condition 2 and Condition 3 (uncertainty about e-cigarette harms).

Conclusions:

Tweets stating misinformation that e-cigarettes were as harmful or more harmful than smoking regular cigarettes may receive higher engagement than tweets indicating e-cigarettes were completely harmless. Clinical Trial: International Standard Randomized Controlled Trial Number (ISRCTN) 16082420; https://doi.org/10.1186/ISRCTN16082420