JUUL: Spreading Online and Offline

Purpose: The increasing popularity of the JUUL electronic nicotine delivery system among youth poses several potential public health concerns. Social media can be used to better understand the spread of information related to JUUL. This study examined whether adolescents (age < 18) are following JUUL's official Twitter account and subsequently sharing (retweeting) JUUL's posts to their followers. We also assessed various patterns in which adolescents share information on JUUL with each other.

Methods: We collected 3,239 tweets from JUUL's official Twitter account (@JUULVapor) for one full year from February 2017 to January 2018. These tweets were shared by Twitter users to their followers 1,124times by 721 unique users. Users were determined to be either adolescent (age <18) or adult (≥18) based on a systematic procedure involving double coding. We used social network analysis to explore the relationships between users retweeting JUUL.

Results: One-quarter (25%) of users were determined to be adolescents. Social network analysis revealed a maximum path length of 4 and a positive assortativity (r = .29). There were 25 (9%) instances of an adolescent retweeting content from another adolescent, 35 (12%) of an adolescent retweeting from an adult, and 30 (11%) of an adult retweeting from an adolescent.

Conclusions: JUUL's official Twitter account is being followed-and its messages are being shared-by adolescents. Rigorous policies and prevention programs are needed to curb adolescent exposure to JUUL content and discussions online.