JMIR Publications

ABSTRACT

Tobacco harm reduction (THR) has become a prominent theme in global tobacco discourse, with much of the messaging driven by industry actors on social media. Despite its growing prevalence, empirical understanding of how THR is framed and debated online remains limited. This study analyzed 17,361 posts on X (formerly Twitter) from 87 countries between July 2019 and December 2023, examining message valence (pro-, anti-, mixed, or none), stakeholder participation, geographic and temporal variation, and industry involvement. Pro-THR posts constituted the majority (71.4%), surpassing anti-THR (22.6%) and neutral or mixed messages (6.0%). Pro-THR valence was most prevalent in high-income countries and largely driven by THR advocates, industry affiliates, and tobacco users. In contrast, anti-THR posts were more common among governments, tobacco control advocates, and in lower-middle-income regions. Thematic analysis revealed that pro-THR messages emphasized the safety and smoking cessation efficacy of newer nicotine and tobacco products, consumer rights, and distrust of public health entities. Conversely, anti-THR narratives focused on youth protection, the health risks of newer products, and distrust of industry motives, while advocating for complete cessation of all tobacco and nicotine use. Nearly 40% of THR-related posts mentioned newer products, and 16% included marketing attempts. Over the years, there have been notable increases in overall THR post volume, posts by THR advocates, as well as product mentions and marketing efforts—trends that present new challenges for tobacco regulation and public health.