Background Social media present opportunities for public health departments to galvanise interest in health issues. A challenge is creating content that will resonate with target audiences, and determining reactions to educational material. Twitter can be used as a real-time surveillance system to capture individuals’ immediate reactions to education campaigns and such information could lead to better campaigns in the future. A case study testing Twitter's potential presented itself when the California Department of Public Health launched its ‘Still Blowing Smoke’ media campaign about the potential harmful effects of e-cigarettes. Pro-e-cigarette advocacy groups, in response, launched a counter campaign titled ‘Not Blowing Smoke’. This study tracked the popularity of the two campaigns on Twitter, analysed the content of the messages and determined who was involved in these discussions.

Methods The study period was from 22 March 2015 to 27 June 2015. A stratified sampling procedure supplied 2192 tweets for analysis. Content analysis identified pro, anti and neutral e-cigarette tweets, and five additional themes: Marketing Elements, Money, Regulation/propaganda, Health, and Other. Metadata were analysed to obtain additional information about Twitter accounts.

Results ‘Not Blowing Smoke’ was referenced more frequently than ‘Still Blowing Smoke’ on Twitter. Messages commonly objected to government regulation of e-cigarettes, refuted claims that e-cigarette manufactures were aligned with big tobacco, and touted the health benefits of e-cigarette use. E-cigarette companies and vape shops used campaign slogans to communicate with customers on Twitter.

Conclusions Findings showed the time dynamics of Twitter and the possibility for real-time monitoring of education campaigns.