JMIR Publications

ABSTRACT

Background:

Co-use of alcohol and electronic cigarettes (often called vaping) has been linked with long-term health outcomes, including increased risk for substance use disorder. Co-use may have been exacerbated by the 2019 coronavirus (COVID-19) pandemic. Social networking sites may offer insights into current perspectives on poly-substance use.

Objective:

The aims of the current study were to investigate vaping and alcohol co-mentions on Twitter during a time of changing vaping regulations in the United States and the emergence of the COVID-19 pandemic.

Methods:

Tweets including both vape- and alcohol-related terms posted between October 2019 and September 2020 were analyzed using Latent Dirichlet Allocation modeling. Distinct topics were identified and described.

Results:

Three topics were identified: (1) flavors and flavor ban (51.8% of tweets), (2) co-use discourse (17.4%), and (3) availability and access regulation (30.8%). Co-use discussions often portrayed co-use as positive and pro-social. Tweets focused on regulation often used alcohol regulations for comparison. Some focused on perceived overregulation of vaping (compared to alcohol), while others supported limiting youth access but not at the expense of adult access (e.g., stronger age verification over product bans). Across topics, vaping was typically portrayed as less harmful than alcohol use. The benefits of flavors for adult smoking cessation were also discussed. The distribution of topics across time varied across both pre- and post-regulatory change and pre- and post-COVID-19 pandemic declaration suggesting shifts in topic focus salience across time.

Conclusions:

Co-use discussions on social media may expose youth to messaging portraying both alcohol use and vaping in a positive light. In addition, Twitter may be a space where youth are exposed to regulatory debate. Frequent discussions of regulation emphasize the still-evolving vaping policy landscape. Social media content analyses may help regulators and policy makers to better understand and respond to common debates surrounding regulation—particularly as it relates to limiting youth access.