Public Perceptions of Very Low Nicotine Content on Twitter: Observational Study

Nicotine is a highly addictive agent in tobacco products. On June 21, 2022, the US Food and Drug Administration (FDA) announced a plan to propose a rule to establish a maximum nicotine level in cigarettes and other combusted tobacco products.

This study aimed to understand public perception and discussion of very low nicotine content (VLNC) on Twitter (rebranded as X in July 2023).

From December 12, 2021, to January 1, 2023, we collected Twitter data using relevant keywords such as "vln," "low nicotine," and "reduced nicotine." After a series of preprocessing steps (such as removing duplicates, retweets, and commercial tweets), we identified 3270 unique noncommercial tweets related to VLNC. We used an inductive method to assess the public perception and discussion of VLNC on Twitter. To establish a codebook, we randomly selected 300 tweets for hand-coding, including the attitudes (positive, neutral, and negative) toward VLNC (including its proposed rule) and major topics (13 topics). The Cohen κ statistic between the 2 human coders reached over 70%, indicating a substantial interrater agreement. The rest of the tweets were single-coded according to the codebook.

We observed a significant peak in the discussion of VLNC on Twitter within 4 days of the FDA's announcement of the proposed rule on June 21, 2022. The proportion of tweets with a negative attitude toward VLNC was significantly lower than those with a positive attitude, 24.5% (801/3270) versus 37.09% (1213/3270) with P<.001 from the 2-proportion z test. Among tweets with a positive attitude, the topic "Reduce cigarette consumption or help smoking cessation" was dominant (1097/1213, 90.44%). Among tweets with a negative attitude, the topic "VLNC leads to more smoking" was the most popular topic (227/801, 28.34%), followed by "Similar toxicity of VLNC as a regular cigarette" (223/801, 27.84%), and "VLNC is not a good method for quitting smoking" (211/801, 26.34%).

There is a more positive attitude toward VLNC than a negative attitude on Twitter, resulting from different opinions about VLNC. Discussions around VLNC mainly focused on whether VLNC could help people quit smoking.