Introduction
The public most frequently associates tobacco use solely with
pulmonary health risks, despite heart disease being the leading cause of death in
smokers. The health perceptions of e-cigarettes, especially cardiovascular health,
have not been well studied. We aimed to evaluate the prevalence and health
perceptions of tweets related to cardiovascular, pulmonary, and brain health –
three organ systems for which tobacco use is a major disease risk factor.
METHODS We examined the cardiovascular, pulmonary, and brain health perceptions
of vaping and JUUL on Twitter, followed by a content analysis of tweets pertaining
to the cardiovascular risks. A Twitter firehose API scraped about 6.2 million
publicly available tweets from 2015–2019 that contained vaping-related terms,
and a separate dataset of about 1.9 million tweets that contained the term JUUL.
A quantitative content analysis (n=2145) of tweets was subsequently conducted
to assess the health perceptions of vaping and JUUL. Two trained coders
independently assessed the posts and Twitter profiles to determine age (<18 or
≥18 years), sex, race, sentiment towards JUUL, and vaping-related topics.
RESULTS The majority of tweets containing vaping or JUUL-related terms did not
also contain cardiovascular, pulmonary, or brain health terms (97.99% and 96.67%,
respectively). Multiple linear regression analysis showed that youth (<18 years),
females, non-White individuals, mention of a flavor, and mention of cardiovascular
health harm words were associated with more positive sentiments towards JUUL.
Pearson’s chi-squared analyses indicated that youth were more likely to mention
a JUUL flavor. Females and youth were more likely to reference cardiovascular
terms with humor.
Conclusions
The cardiovascular health risks of vaping are not fully recognized by
the public. Vulnerable populations such as youth and females reference JUUL
with cardiovascular-related words that downplay the severity of tobacco as a major
risk factor for cardiovascular disease.
Publication: Tobacco Induced Diseases
Co-author: Jiaxi Wu (Doctoral Student in EMS), Derry Wijaya (faculty, BU Computer Science); Jessica Fetterman (Faculty, BU School of Medicine); Ziming Xuan (Faculty, BU School of Public Health)