JMIR Publications

ABSTRACT

Background:

Nicotine is a highly addictive agent in tobacco products. On June 21, 2022, the US Food and Drug Administration (FDA) announced a plan to propose a rule to establish a maximum nicotine level in cigarettes and other combusted tobacco products.

Objective:

This study aims to understand public perception and discussion of VLNC (Very Low Nicotine Content) on Twitter/X.

Methods:

From December 12, 2021, to January 1, 2023, we collected Twitter/X data using relevant keywords such as “vln”, “low nicotine”, and “reduced nicotine”. After a series of pre-processing steps (such as removing duplicates, retweets, and commercial tweets), we identified 3,270 unique non-commercial tweets related to VLNC. We used an inductive method to assess the public perception and discussion of VLNC on Twitter/X. To establish a codebook, we randomly selected 300 tweets for hand-coding, including the attitudes (positive, neutral, and negative) toward VLNC and major topics (14 topics). The Cohen’s Kappa statistic between the two human coders reached over 70%, indicating a substantial interrater agreement. The rest of the tweets were single-coded according to the codebook.

Results:

We observed a significant peak in the discussion of VLNC on Twitter/X within four days of the FDA’s announcement of the proposed rule on June 21, 2022. The proportion of tweets with a negative attitude towards VLNC was significantly higher than those with a positive attitude, 32.45% (1,061/3,270) vs. 28.99% (948/3,270) with a P-value of 0.003 from the two-proportion Z-test. Among tweets with a positive attitude, the topic “Help smoking or vaping cessation” is dominant (53.69%, 509/948). Among tweets with a negative attitude, the topic “Same or more toxic of VLNC” is the most popular topic (21.49%, 228/1,061), followed by “VLNC leads to more smoking” (20.36%, 216/1,061), “Other” (18.10%, 192/1,061), and “VLNC is not a good method for quitting smoking” (17.44%, 185/1,061).

Conclusions:

There is a more negative attitude toward VLNC than a positive attitude on Twitter/X, resulting from different opinions about VLNC. Discussions around VLNC mainly focused on whether VLNC could help quit smoking and its toxicity.