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Observational Study
. 2020 Jun 22;22(6):e17496.
doi: 10.2196/17496.

A Social Media Study on the Associations of Flavored Electronic Cigarettes With Health Symptoms: Observational Study

Long Chen  1 , Xinyi Lu  1 , Jianbo Yuan  1 , Joyce Luo  2 , Jiebo Luo  1 , Zidian Xie  3 , Dongmei Li  3
Affiliations
Observational Study

A Social Media Study on the Associations of Flavored Electronic Cigarettes With Health Symptoms: Observational Study

Long Chen et al. J Med Internet Res. .

Abstract

Background: In recent years, flavored electronic cigarettes (e-cigarettes) have become popular among teenagers and young adults. Discussions about e-cigarettes and e-cigarette use (vaping) experiences are prevalent online, making social media an ideal resource for understanding the health risks associated with e-cigarette flavors from the users' perspective.

Objective: This study aimed to investigate the potential associations between electronic cigarette liquid (e-liquid) flavors and the reporting of health symptoms using social media data.

Methods: A dataset consisting of 2.8 million e-cigarette-related posts was collected using keyword filtering from Reddit, a social media platform, from January 2013 to April 2019. Temporal analysis for nine major health symptom categories was used to understand the trend of public concerns related to e-cigarettes. Sentiment analysis was conducted to obtain the proportions of positive and negative sentiment scores for all reported health symptom categories. Topic modeling was applied to reveal the topics related to e-cigarettes and health symptoms. Furthermore, generalized estimating equation (GEE) models were used to quantitatively measure potential associations between e-liquid flavors and the reporting of health symptoms.

Results: Temporal analysis showed that the Respiratory category was consistently the most discussed health symptom category among all categories related to e-cigarettes on Reddit, followed by the Throat category. Sentiment analysis showed higher proportions of positive sentiment scores for all reported health symptom categories, except for the Cancer category. Topic modeling conducted on all health-related posts showed that 17 of the top 100 topics were flavor related. GEE models showed different associations between the reporting of health symptoms and e-liquid flavor categories, for example, lower association of the Beverage flavors with Respiratory compared with other flavors and higher association of the Fruit flavors with Cardiovascular than other flavors.

Conclusions: This study identified different potential associations between e-liquid flavors and the reporting of health symptoms using social media data. The results of this study provide valuable information for further investigation of the health effects associated with different e-liquid flavors.

Keywords: e-cigarette; eHealth; social media.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Monthly health-related posts count and proportion of health-related posts (normalized to electronic cigarette–related posts) from January 2013 to April 2019. The blue, shaded region indicates the period where the US Food & Drug Administration (FDA) released the 2016 Federal Food, Drug and Cosmetic Act (FD&C Act).
Figure 2
Figure 2
Heatmap of the estimated probabilities of associations between e-liquid flavors and health symptoms on Reddit.
See this image and copyright information in PMC

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