Why do people use electronic nicotine delivery systems (electronic cigarettes)? A content analysis of Twitter, 2012-2015

The reasons for using electronic nicotine delivery systems (ENDS) are p oorly understood and are primarily documented by expensive cross-sectional surveys that use preconceived close-ended response options rather than allowing respondents to use their own words. We passively identify the reasons for using ENDS longitudinally from a content analysis of public postings on Twitter. All English language public tweets including several ENDS terms (e.g., "e-cigarette" or "vape") were captured from the Twitter data stream during 2012 and 2015. After excluding spam, advertisements, and retweets, posts indicating a rationale for vaping were retained. The specific reasons for vaping were then inferred based on a supervised content analysis using annotators from Amazon's Mechanical Turk. During 2012 quitting combustibles was the most cited reason for using ENDS with 43% (95% CI 39-48) of all reason-related tweets cited quitting combustibles, e.g., "I couldn't quit till I tried ecigs," eclipsing the second most cited reason by more than double. Other frequently cited reasons in 2012 included ENDS's social image (21%; 95% CI 18-25), use indoors (14%; 95% CI 11-17), flavors (14%; 95% CI 11-17), safety relative to combustibles (9%; 95% CI 7-11), cost (3%; 95% CI 2-5) and favorable odor (2%; 95% CI 1-3). By 2015 the reasons for using ENDS cited on Twitter had shifted. Both quitting combustibles and use indoors significantly declined in mentions to 29% (95% CI 24-33) and 12% (95% CI 9-16), respectively. At the same time, social image increased to 37% (95% CI 32-43) and lack of odor increased to 5% (95% CI 2-5), the former leading all cited reasons in 2015. Our data suggest the reasons people vape are shifting away from cessation and toward social image. The data also show how the ENDS market is responsive to a changing policy landscape. For instance, smoking indoors was less frequently cited in 2015 as indoor smoking restrictions became more common. Because the data and analytic approach are scalable, adoption of our strategies in the field can inform follow-up survey-based surveillance (so the right questions are asked), interventions, and policies for ENDS.