Original research Tob Control: first published as 10.1136/tobaccocontrol-2019-055427 on 20 March 2020. Downloaded from At the speed of Juul: measuring the Twitter conversation related to ENDS and Juul across space and time (2017–2018) Yoonsang Kim ,1 Sherry L Emery,1 Lisa Vera,2 Bryn David,3 Jidong Huang 4 ► Additional material is ABSTRact to access and share information about the prod- published online only. To view Background Electronic nicotine delivery systems ucts.11 12 please visit the journal online A new generation of ENDS gained traction in (http:// dx. doi. org/ 10. 1136/ (ENDS) are the most- used tobacco product by tobaccocontrol- 2019- 055427). adolescents, and Juul has rapidly become the most the US market in 2017. These products, collec- popular ENDS brand. Evidence indicates that Juul has tively called ‘pod vapes’, resemble flash drives and 1 Social Data Collaboratory, been marketed heavily on social media. In light of recent are rechargeable at USB ports. The largest brand Public Health, NORC at the of pod vapes is Juul, first introduced in June 2015 University of Chicago, Chicago, lawsuits against the FDA spurred by claims that the Illinois, USA agency responded inadequately to this marketing push, and manufactured by Juul Labs, Inc. Only a year 2VeraCite Inc, La Jolla, measuring the social media conversation about ENDS after its entry to the ENDS market, Juul achieved California, USA market domination. Juul’s sales growth coin- 3 like Juul has important public health implications. Center for Excellence in cided with a surge in innovative and engaging Survey Research, NORC at the Methods We employed search filters to collect Juul- University of Chicago, Chicago, related and other ENDS- related data from Twitter in social media campaigns conducted by Juul, online Illinois, USA 2017–2018 using Gnip Historic PowerTrack. Trained ENDS vendors, social media influencers and retail 4 13–15 School of Public Health, coders labelled random samples for Juul and ENDS stores. Georgia State University, relevance, and the labelled samples were used to train Because of its popularity and its dominant market Atlanta, Georgia, USA 16 a supervised learning classifier to filter out irrelevant position, Juul has become eponymous for all pod- style vape devices, and their use is termed ‘Juuling’.14 Correspondence to tweets. Tweets were geolocated into US counties and Dr Yoonsang Kim, Public Health, their fitness for use was assessed. The Juul brand and other brands of pod vapes, NORC at the University of Results The amount of Juul- related tweets increased along with ENDS marketers, online vendors and Chicago, Chicago, IL 61259, retail stores, aggressively employed social media to 67 times over the study period (from 18 849 in the copyright. USA; Kim- Yoonsang@ norc. org first quarter of 2017 to 1 287 028 in the last quarter of advertise and promote Juul and Juuling, and there is evidence that adolescents actively participate in Received 3 October 2019 2018), spreading widely across US counties. By the last 17–20 Revised 11 February 2020 quarter 2018, 34% of US counties had more than 6 Juul- Juul- related social media conversations. Accepted 18 February 2020 related posts per 10 000 people, up from 0% in the first Although ENDS marketing and promotion on quarter 2017. However, during the same period, the total social media have been largely unregulated, the FDA has increased its scrutiny of ENDS products of non- Juul ENDS- related tweets decreased by 25%. and marketing since the issuance of the Deeming Conclusions Juul- related content grew exponentially 21 http://tobaccocontrol.bmj.com/ on Twitter and spread across the entire country during regulation in 2016. Partly due to concerns regarding Juul’s rapid ascension to youth popu- the time when the brand was gaining market share. larity, in March 2018 a coalition of public health This social media buzz continued to increase even after groups sued the FDA for delaying rules on ENDS FDA’s multiple interventions to curb promotions targeting and cigars by granting lengthy deadline extensions minors. to manufacturers seeking product approval.22 In response, between April and June 2018 the FDA issued a series of warning letters and civil fines to retailers who illegally sold Juul and other ENDS INTRODUCTION to minors.23 In October that year, facing rising Electronic nicotine delivery systems (ENDS) have concerns about advertising targeting youth, the on September 30, 2021 by guest. Protected been the most popular tobacco product among FDA conducted a surprise inspection of Juul Labs’ 1 adolescents in the USA since 2014, sparking headquarters, seizing documents related to its sales concerns among the public health community and marketing practices.24 In an ostensible effort to regarding increases in youth nicotine addiction curb Juul use by minors, and in response to public and transition to combustible cigarette smoking. outcry and the FDA’s warnings, Juul announced in © Author(s) (or their In 2016, 4 out of 5 youth in the National Youth June 2018 that it would “no longer use models on employer(s)) 2020. Re- use Tobacco Survey reported exposure to ENDS adver- social media platforms”. Juul also removed all non- 2 permitted under CC BY- NC. No tising from at least one media source, and adver- tobacco, non- menthol flavours from its 90 000+ commercial re- use. See rights tising exposure has been associated with ENDS use retail outlets’ shelves, and shut down its Facebook and permissions. Published 3 4 by BMJ. among adolescents. Further evidence indicates and Instagram accounts in November 2018 with a that social media are a dominant avenue for ENDS promise that it would limit its presence on Twitter To cite: Kim Y, Emery SL, product advertising, particularly aimed at youth to non- promotional communication and would Vera L, et al. Tob Control 5–7 Epub ahead of print: [please and young adults ; studies have demonstrated that ask social media platforms (including Twitter) include Day Month Year]. ENDS are marketed heavily on social media plat- to prohibit posts that promote underage use of doi:10.1136/ forms such as Instagram, Twitter and YouTube.8–10 ENDS.25 26 In response to recently reported vaping- tobaccocontrol-2019-055427 ENDS users actively engage on social networks related lung illnesses and deaths, and the intensified Kim Y, et al. Tob Control 2020;0:1–10. doi:10.1136/tobaccocontrol-2019-055427 1 Original research Tob Control: first published as 10.1136/tobaccocontrol-2019-055427 on 20 March 2020. Downloaded from scrutiny and regulatory responses from FDA and several states, are used, marketed and relevant information is shared among Juul suspended all broadcast, print and digital product adver- young people. Twitter users are younger than the general popu- tising in the US in September 2019.27 lation37; 32% of online teens38 and 45% of young adults (aged Brands, influencers and regular people share promotional 18–24 years) use Twitter.39 Further, it has been estimated that content, opinions, reviews, intentions and behaviours related to adolescents actively participate in tweeting about Juul.20 40 In ENDS use—including Juuling—on social media platforms. One addition, Twitter has been considered an important data source recent study illuminated Juul’s popularisation on Twitter, finding for addressing/monitoring emerging issues and products in that a majority of Juul-related tweets collected mentioned public health surveillance or epidemiological research41 because personal use (eg, ‘juuling’), where Juul was used (eg, school, the Twitter application programming interfaces (APIs) enable bathroom), its resemblance to a flash drive, Juul as a gift/holiday near real-time data collection. costume, or addiction/nicotine dependence.28 Other research We analysed the amount of Juul-related and non- Juul ENDS- suggests that users share thoughts, behaviours and information related posts on Twitter between January 2017 and December regarding Juul with other users potentially bonding around Juul 2018 across the 3142 counties of the US. Mapping tweets to use on Twitter; and that few Twitter users mention smoking geolocations is key to characterise the ENDS- related PCE and cessation with Juul, despite the manufacturer’s branding of Juul observe geographical variations of the PCE. The objectives of as a smoking alternative.29 this study are twofold: to construct the PCE measures of Juul- ENDS- related content on social media has powerful poten- related and non- Juul ENDS- related posts using Twitter data tial to influence ENDS use by modelling, normalising and even and examine its fitness for use; and to study how quickly and incentivising the behaviour.30–33 To date, research on individuals’ widely Juul- related messages spread across the US. This analysis exposure to ENDS-related social media posts has relied on self- draws on methods we have previously developed and applied to report (ie, survey) measures. However, self-reported exposure characterising ENDS-related social media posts,42 and advances measures can suffer from simultaneity bias (also known as endog- those methods to test whether geolocated tweets introduce selec- eneity), which causes measurement errors: individuals who are tion bias resulting from systematic differences between users interested in using ENDS or already use those products will have who allow geolocation identification and those who do not.43 greater opportunities for exposure to ENDS-related messages on Thus, we also assess possible bias and the statistical ‘fitness for social media because of their online search activities and social use’ of geolocated tweets in the PCE characterisation.44 45 This networks.34 In addition, self- report carries the risk of recall or study will contribute to the knowledge on statistical property salience bias: respondents who use or are interested in ENDS of geolocated tweets and social media measurement related to may be more likely to recall seeing ENDS-related posts because ENDS products.