Dual Tobacco Use Research Articles

Factors Associated With Cannabis Use Among African American Nondaily Smokers.

Cannabis and tobacco dual use is a growing concern in the United States, especially among African Americans (AAs). Dual use increases nicotine dependence and poses negative health effects. Despite decreasing numbers of people who smoke daily, nondaily smokers (NDS) are increasing. Polytobacco use, including blunt use, is higher in AA NDS than AAs who smoke daily. This study examined factors associated with cannabis use among AA NDS. Adult AA NDS participated in a randomized controlled trial (n = 278) for smoking cessation. A subset of this sample (n = 262; mean age 48.2 years; 50% male) was analyzed to identify correlates of cannabis use. Logistic regression assessed the associations of demographic, smoking-related, and psychosocial variables with cannabis use. Participants smoked cigarettes on an average of 18 days of the last 30 and used 4.5 cigarettes on smoking days. Of the participants analyzed, 38% used cannabis, including blunts (ie, cigars hollowed out filled with cannabis) at baseline. Cannabis use was associated with polytobacco product use not including blunts (odds ratio [OR] 2.11, 95% confidence interval [CI] 1.18-3.77, P = 0.012), depressive symptoms (OR 1.22, 95% CI 1.05-1.42, P = 0.011), and younger age (OR 0.97, 95% CI 0.94-0.99, P = 0.004). Rates of cannabis and tobacco dual use in our sample exceed national rates. Dual use poses harmful health effects that exceed the risk of either substance alone. Findings will inform future work in tailoring treatments to vulnerable groups of people who use both tobacco and cannabis.

Social determinants of dual tobacco use in India: An analysis based on the two rounds of global adult tobacco survey.

This study examines the socioeconomic determinants of dual use of smoked and smokeless tobacco (SLT) in India between 2009-10 and 2016-17. Data from two rounds of the nationally representative cross-sectional Global Adult Tobacco Survey (GATS) conducted in 2009-10 and 2016-17 was used. Complete sample size from both rounds of survey covering 143,333 individuals (GATS I: 69,296 and GATS II: 74,037) from 153,239 households (GATS I: 76,069 and GATS II: 77,170) included in the study. Dual use was assessed based on current smoked and SLT users in both rounds. Bivariate analysis was applied to assess differences in dual tobacco use by socioeconomic status (SES) and across regions, whereas, pooled sampled analysis was conducted to examine the determinants of dual use applying multinomial logistic regression model. Findings reveal that dual use has declined in India from nearly 5% in 2009-10 to 3.4% in 2016-17. Considerable regional and SES differences in dual use are evident. Multivariate results indicate, while age is positively associated with dual use, education and household wealth was negatively associated. Dual use of tobacco was found to be considerably higher among men as compared to women (RRR: 15.66, 95%CI 14.20-17.27). Awareness about the adverse health consequences of tobacco was also negatively associated with dual tobacco use (RRR: 0.56, 95%CI 0.50-0.64). Future awareness and enforcement efforts should focus on all forms of tobacco, especially targeting vulnerable SE groups.

Dual Burden of Smoked and Smokeless Tobacco Use in India, 2009-2017: A Repeated Cross-Sectional Analysis Based on Global Adult Tobacco Survey.

The dual use of smoked and smokeless tobacco (SLT) poses a serious challenge to tobacco control efforts. This article examines the trends and patterns of this usage in India during the period 2009-2010 and 2016-2017. Data from two rounds of nationally representative cross-sectional Global Adult Tobacco Survey (GATS) conducted in 2009-2010 and 2016-2017 have been used. Dual use was assessed based on current smokers and SLT users in both rounds. Findings reveal that dual use in India has dropped from 5.3% during 2009-2010 to 3.4% during 2016-2017, a decline of nearly 10 million dual users. However, some states have added nearly 4.6 million new dual users during this period. While dual use continues to remain high in rural areas, there has been a manifold increase in urban areas. Findings revealed that intention to quit tobacco was lower among dual tobacco users as compared to single users with considerable difference between urban and rural areas. Easy availability and affordability of SLT products compared to smoking products and restrictions on smoking in public places may have pushed current smokers and dual users to take to or intensify their SLT consumption. Measures relating to awareness, pricing, taxation, and enforcement of tobacco control laws should focus on all forms of tobacco, especially targeting high dual burden in rural and urban settings. Dual form of tobacco users represent 12% of all tobacco users in the country. The study reveals that intention to quit tobacco among dual users is significantly lower than that among single tobacco product users. This requires improving public awareness about the morbidity and mortality that arises from the use of all forms of tobacco products. Efforts to restrict the availability of tobacco products should focus on licensing the sale of all tobacco products. Reduction in dual tobacco use will not only result in multiplied health benefits but also help in achieving the Non-Communicable Diseases targets under the United Nations Sustainable Development Goals.

Factors associated with dual use of waterpipe tobacco and cigarettes among adults in Pakistan

Little is known about dual use of waterpipe tobacco and cigarettes, especially in countries where both are prevalent. This study aimed to assess demographic correlates, patterns of use and quit behaviours of waterpipe users in Pakistan who also smoke cigarettes. Data were taken from a randomized controlled trial in Pakistan that assessed smoking cessation in 510 adult waterpipe users, stratified on concurrent cigarette use. Logistic regression analysis was done to assess the association between waterpipe tobacco users who also smoke cigarettes (dual use) and their demographic characteristics, smoking history and quit behaviour. Unadjusted odds ratios (OR) and adjusted OR (ORa) and 95% confidence intervals (CI) were determined. Dual use was significantly associated with younger age (ORa = 0.36, 95% CI: 0.19-0.70) and middle-school educational level (11-15 years), versus no formal education, (ORa = 2.01, 95% CI: 1.15-3.50). Dual use was also associated with smoking less than all day versus all day (defined as continuously for several hours) (ORa = 2.71, 95%: CI 1.73-4.25) and younger age at starting smoking (ORa = 0.95, 95% CI: 0.93-0.98). No association was found between dual use and sex, marital status, duration of smoking, nicotine dependence or quit history. Waterpipe tobacco users who also smoke cigarettes differ from waterpipe-only users, particularly in demographic characteristics. More research is needed to explore the interaction between these two smoking behaviours. Health promotion and cessation interventions in Pakistan should consider tailoring their approach to account for the unique characteristics of dual waterpipe and cigarette users.

Tobacco and E-cigarette use among cancer survivors in the United States.

BackgroundLimited information exist on tobacco and e-cigarette use patterns in cancer survivors. The purpose of this study is to report on use patterns in cancer survivors compared with non-cancer participants from the Population Assessment of Tobacco and Health (PATH) Study.MethodsSociodemographic data and tobacco product use were analyzed for 32,244 adult participants from the PATH Study in 2013–2014 by cancer status and age. Logistic regression examined the patterns of and factors associated with tobacco use by cancer status.ResultsOverall, cancer survivors represented 7.1% (n = 1,527) of participants, were older, and had a higher proportion of females and non-Hispanic whites than non-cancer participants. In cancer survivors, current and former cigarette smoking was reported in 12.7% and 32.9% respectively, compared with 18.5% and 19.0% in non-cancer adults. Current e-cigarette use was reported by 3.8% of survivors compared with 5.7% of non-cancer participants. Dual tobacco use was reported by 25.0% and poly use by 6.9% of cancer survivors who currently smoked. All other forms of current tobacco use were individually reported by <5% of survivors. Young adult cancer survivors (aged 18–44) reported the highest rates of current cigarette smoking (27.9%) and current e-cigarette use (11.8%). The effects of age, sex, race/ethnicity, education, and income on tobacco use status were comparable for cancer survivors and non-cancer participants. Cancer survivors who were younger, male, of lower educational attainment, and those diagnosed with a tobacco-related cancer were more likely to report current tobacco use.ConclusionsAmong cancer survivors, cigarette smoking remains the predominant form of tobacco use, although other tobacco/nicotine use and dual/poly use are common. The PATH Study provides detailed tobacco product use patterns in survivors, including their adoption of emerging alternative tobacco products.

P1.04 Prevalence, Pattern and Factors Associated with Dual Tobacco Use in a Rural Community in South Eastern Nigeria

National prevalence studies have consistently shown higher rates of dual tobacco use in South Eastern Nigeria but little is known about the pattern and factors associated with dual tobacco use in these parts of the country. Dual tobacco use is a greater health problem than mono use and needs to be researched. The aim of this study was to determine the pattern and factors associated with dual tobacco use among residents of a rural community in South Eastern Nigeria. A cross-sectional descriptive study was carried out among 490 residents of GBpo community selected using a two-stage sampling method. Data was collected using a pre-tested interviewer-administered questionnaire adapted from the Global Adult Tobacco Survey. Odd ratios and 95% confidence intervals were computed and P values of < 0.05 were considered statistically significant. The results showed that respondents were mostly male 300(61.2%) and aged between 20 and 70 years with a mean of 42.2 ± 15.4 years. Almost a quarter of the respondents, 101 (20.6%) were ever- dual tobacco users. Also, 210(42.9%) use only smokeless tobacco while only 110 (22.4%) use only smoked tobacco Dry snuff (73.8% of smokeless tobacco forms) cigarettes 82.2% (of smoked tobacco forms) were the most common forms of tobacco used. The primary reasons for tobacco use were: to relieve stress (61.2%); to increase levels of alertness (56.4%); for personal pleasure (55.9%) and social acceptance (52.1%). Age (p<0.0001), male gender (p<0.0001) and lower educational attainment (p<0.0001) were associated with dual tobacco use. About half of the respondents (51%) were aware that dual tobacco is more dangerous to human health than mono use and only about (27.1%) were aware that tobacco use is associated with lung cancer and COPD. Many of the respondents agreed that tobacco is a way of promoting friendship (65%) and should be used within their community (73%). Efforts targeted at raising community awareness of the health effects of dual tobacco use are needed in rural communities where dual tobacco use is disproportionately high. Programs should be directed to males with lower educational attainment.

Dual use of electronic cigarettes and tobacco in New Zealand from a nationally representative sample

ObjectiveThere is strong interest in the use of electronic cigarettes (e‐cigarettes) globally. Not much is known about the dual use of e‐cigarettes and combustible tobacco cigarettes, or if there are demographic differences among dual users and e‐cigarette only users. This paper reports on the demographics of dual users and e‐cigarette only users in New Zealand in a nationally representative sample. MethodsThe Health and Lifestyles Survey (HLS) is a biennial face‐to‐face in‐house survey of New Zealand adults aged 15 years or over. The HLS was completed by 3,854 participants in 2016. ResultsThere is clear evidence of significant dual use in the current sample: most current e‐cigarette users (63.9%) were dual users. Respondents 45 years and older were twice as likely to be dual users as those aged 15 to 34 years. ConclusionThe current study found evidence for substantial dual use of e‐cigarettes and combustible tobacco cigarettes among adult e‐cigarette users, particularly among users aged 45 years and over. Implications for public healthPublic health initiatives should provide clear advice that e‐cigarettes should be used as a smoking cessation tool and not as a way to allow the consumption of combustible tobacco to continue.

Flavored tobacco use is associated with dual and poly tobacco use among adolescents

ObjectivesThis study examines the relationships between flavored tobacco use and single, dual, and poly tobacco product use, among adolescents. Given the increased use of flavored tobacco products, it is vital to understand if flavored products are associated with dual and poly tobacco product use. MethodsData were obtained from the 2017 National Youth Tobacco Survey. Participants were 2042 adolescent past 30-day tobacco users. Multivariable multinomial logistic regression models were used to assess the relationship between flavored tobacco use and past 30-day single, dual, and poly (three or more) tobacco product use. Two analyses were conducted using different categories as referent groups to allow for a comprehensive examination of the relationship between all groups. Covariates included sex, grade level, race/ethnicity and exposure to tobacco marketing. ResultsApproximately half of all adolescent tobacco users (45.7%) reported use of more than one product. The majority of adolescent tobacco users reported using flavors (69.4%). Flavored tobacco use was significantly correlated with a greater risk of dual (RRR: 2.09) and poly (RRR: 5.54) tobacco use, relative to single product use, controlling for covariates. Similarly, flavored tobacco use was significantly correlated with a greater risk of poly (RRR: 2.66) tobacco use, relative to dual tobacco use, controlling for covariates. ConclusionsA positive relationship was observed for flavored tobacco use and multiple tobacco product use. Findings suggest the need to consider stronger regulations of flavored tobacco products. Similarly, as most adolescent tobacco users reported using flavors, findings suggest the need to emphasize flavored tobacco use in prevention and education programs.

Prevalence and correlates of dual tobacco use in cancer survivors.

Tobacco use in cancer survivors remains a significant problem, however, the use of non-cigarette tobacco products (NCTPs) in this population is less understood. This study examined prevalence and correlates of tobacco use among cancer survivors who were never, current, and former cigarette users. Tobacco-related behaviors and quitting attitudes were compared between survivors dually using cigarettes and electronic cigarettes (ECs) and cigarette-only users. In this cross-sectional study, patients at Mid-South cancer centers (n = 629; 50.4% never, 17.8% current, and 31.8% former cigarette users) responded to an anonymous questionnaire about tobacco-related behaviors and quitting attitudes. Among current cigarette users, 27.7% reported using two or more tobacco products. Most commonly, 15.2% of cigarettes users were using ECs. Compared to cigarette only use, dual use of tobacco products was associated with male gender (p < 0.0001), being single (p = 0.009), and a lung cancer diagnosis (p < 0.0001). Dual users of cigarettes and ECs were more likely to report a readiness to quit cigarettes within 6 months (p = 0.0317) and that a physician recommended ECs as a quit resource (p = 0.0361) compared to cigarette-only users. Results suggest that using more than one tobacco product is common among cancer survivor cigarette users. Dual use of cigarettes and ECs was associated with an increased readiness for cigarette cessation and a physician recommendation of ECs. Targeting potential dual use of tobacco products, particularly cigarettes and ECs, might be beneficial for cigarette cessation among cancer survivors.

WITHDRAWN: Flavored Tobacco Use is Associated with Dual and Poly Tobacco Use among Adolescents

WITHDRAWN: Flavored Tobacco Use is Associated with Dual and Poly Tobacco Use among Adolescents

Exclusive versus dual use of tobacco and electronic cigarettes among adolescents in Poland, 2010–2016

Globally, electronic cigarette (e-cigarette) use among adolescents has increased, along with concerns about potential health implications from exclusive and concurrent tobacco and e-cigarette use (i.e., “dual use”). This study used data from a cross-sectional survey administered to 5708 students aged 15–19 in secondary and technical schools throughout two regions of Poland. Data from 2010–2011 (n = 1760); 2013–2014 (n = 1970) and 2015–2016 (n = 1978) were analyzed to assess changes in use of cigarettes and e-cigarettes from 2010–2016, and correlates of exclusive and dual use, daily use, and intensity of product use from 2013–2016. In this sample, e-cigarette trial and past 30-day exclusive e-cigarette use significantly increased over time (2010–2011: 2%; 2013–2014: 8%; 2015–2016: 11% (p < .05)). Dual use increased from 2010–2011 (4%) to 2013–2014 only (23%, p < .05); and remained stable from 2013–2014 to 2015–2016 (24%, p = .60). Most dual users reported using cigarettes before trying e-cigarettes (82% in 2013–2014, 76% in 2015–2016). Analyses comparing dual users to exclusive users showed significant differences in frequency and intensity of product use, similar findings were observed within dual users. Following the introduction of e-cigarettes, both total tobacco use and total cigarette use increased. Among youth in Poland, e-cigarettes do not seem to replace conventional cigarettes, but instead contribute to a more diverse array of available products from which youth can experiment.

Prevalence and Correlates of Electronic Cigarette Use Among a Clinical Sample of Polysubstance Users in Kentucky: Long Live the Cigarette?

Background: E-cigarette use has increased in the US, yet, in some regions rates of cigarette use remain high. Purpose: To describe the prevalence and features of lifetime and past-year e-cigarette use among a clinical sample of polysubstance users in Kentucky, and to determine significant associations of past-year e-cigarette use. Results: Of the final sample (N = 497), 83.5% reported having ever used e-cigarettes and 97.2% reported having ever used cigarettes. These rates surpass those found among Kentucky’s general population. Compared to those who did not report e-cigarette use, e-cigarette users were more likely to be younger ( = 33.4 vs. 43.6, p<.001) and White (88.2.1% vs. 62.5%, p = .001). E-cigarette users showed higher rates for lifetime incarceration (91.1% vs. 72.8%, p = .001) and past-year arrest (75.0% vs. 47.5%, p = .001). This group also presented with more severe substance use history and lower mean age for illicit drug use initiation ( = 13.8 vs. 16.4, p = .001). Approximately 65% of the sample reported past-year e-cigarette use and 96.6% reported past-year cigarette use. Logistic regression indicated that being younger (AOR = .973, p = .030), White (AOR = 1.92, .046), having a past-year arrest (AOR = 1.73, p = .047) and having used cigarettes (AOR = 8.93, p = .001) or kratom (AOR = 3.04, p = .025) within the past year were significantly associated with past-year e-cigarette use. Conclusions: E-cigarette use was related to more severe drug-using patterns. Rates of dual tobacco use among this sample are high, particularly among younger individuals. In ecological contexts where cigarette use remains normative, it is likely that dual use will persist for nicotine-dependent, polysubstance-using individuals.

Opium use during pregnancy and infant size at birth: a cohort study

BackgroundThe reported positive association between opiatic drug use during pregnancy and adverse pregnancy outcomes might be confounded by other factors related to high-risk behaviors, including the use of other harmful substances. In rural areas of Iran, opium use during pregnancy is relatively common among women who otherwise do not have a hazardous lifestyle, which reduces the risk of residual confounding and increasing the possibility to identify its effects. We aimed to examine the association of antenatal exposure to opium with risks of small for gestational age, short birth length, and small head circumference at birth.MethodIn this cohort study in the rural area of the Golestan province, Iran, we randomly selected 920 women who were exposed to opium during pregnancy and 920 unexposed women during 2008–2010. Log-binomial regression was used to estimate risk ratios (RR) and 95% confidence intervals (CI) for the associations between prenatal exposure to opium and risks of small for gestational age, short birth length, and small head circumference at birth.ResultsCompared with non-use of opium and tobacco during pregnancy, using opium only and dual use of opium and tobacco were associated with increased risks of small for gestational age at births (RR = 1.71; 95% CI 1.34–2.18 and RR = 1.62; 95% CI 1.13–2.30, respectively). Compared with non-use of opium and tobacco, exposure to only opium or dual use of opium and tobacco were also associated with more than doubled increased risks of short birth length, and small head circumference in term infants.ConclusionMaternal opium use during pregnancy is associated with increased risks of giving birth to a small for gestational age infant, as well as a term infant with short birth length or small head circumference.

P2.10-12 Prevalence, Pattern and Factors Associated with Dual Tobacco Use in a Rural Community in South Eastern Nigeria

P2.10-12 Prevalence, Pattern and Factors Associated with Dual Tobacco Use in a Rural Community in South Eastern Nigeria

Marijuana use among adolescent multiple tobacco product users and unique risks of dual tobacco and marijuana use

BackgroundAdolescence is a peak time for uptake of both tobacco and marijuana (dual use). This study aimed to identify clusters of lifetime tobacco and marijuana use patterns and associated risk factors, and to determine whether dual tobacco and marijuana use is uniquely associated with greater risk than use of either tobacco or marijuana alone. MethodHigh school students participated in a survey during Fall 2014 (N = 976; 68% Hispanic; 57% parental education < high school). Items from national youth surveys were used to measure lifetime and current use of tobacco products, marijuana, alcohol, drug use, and other risk behaviors, and literature-based surveys were used to measure psychological constructs. ResultsLatent Class Analysis identified three clusters of lifetime tobacco use patterns (no tobacco, one or two products, and more than two products), each with a correspondingly distinct profile of risk behaviors; risk escalated with use of more tobacco products. Multinomial modeling characterized personal, environmental, and behavioral correlates of dual lifetime tobacco and marijuana use, including lower parental monitoring, lower grades, higher guilt, higher lifetime alcohol and drug use, and more substance use by friends, in reference to single lifetime use of either tobacco or marijuana. ConclusionBroader use of tobacco (i.e., more products) was associated with numerous risk factors. Dual lifetime use of tobacco and marijuana was associated with numerous risks compared to single use of either tobacco or marijuana. Longitudinal work is needed to understand temporal relationships between risk variables to determine optimal timing for interventions to reduce harmful behaviors.

The safety, effectiveness and cost-effectiveness of cytisine in achieving six-month continuous smoking abstinence in tuberculosis patients-protocol for a double-blind, placebo-controlled randomized trial.

Background and aimsTuberculosis (TB) patients who quit smoking have much better disease outcomes than those who continue to smoke. In general populations, behavioural support combined with pharmacotherapy is the most effective strategy in helping people to quit. However, there is no evidence for the effectiveness of this strategy in TB patients who smoke. We will assess the safety, effectiveness and cost‐effectiveness of cytisine—a low‐cost plant‐derived nicotine substitute—for smoking cessation in TB patients compared with placebo, over and above brief behavioural support.DesignTwo‐arm, parallel, double‐blind, placebo‐controlled, multi‐centre (30 sites in Bangladesh and Pakistan), individually randomized trial.SettingTB treatment centres integrated into public health care systems in Bangladesh and Pakistan.ParticipantsNewly diagnosed (in the last 4 weeks) adult pulmonary TB patients who are daily smokers (with or without dual smokeless tobacco use) and are interested in quitting (n = 2388).MeasurementsThe primary outcome measure is biochemically verified continuous abstinence from smoking at 6 months post‐randomization, assessed using Russell Standard criteria. The secondary outcome measures include continuous abstinence at 12 months, lapses and relapses; clinical TB outcomes; nicotine dependency and withdrawal; and adverse events.CommentsThis is the first smoking cessation trial of cytisine in low‐ and middle‐income countries evaluating both cessation and TB outcomes. If found effective, cytisine could become the most affordable cessation intervention to help TB patients who smoke.

Dual use of tobacco and cannabis: significant change in use between Prince Edward Island (PEI) and Canadian students (2008/2009 to 2014/2015)

Dual use of tobacco and cannabis: significant change in use between Prince Edward Island (PEI) and Canadian students (2008/2009 to 2014/2015)

&amp;#8220;It Didn't Fill the Void&amp;#8221;: reasons for e-cigarette and tobacco dual use

&amp;#8220;It Didn't Fill the Void&amp;#8221;: reasons for e-cigarette and tobacco dual use

Assessment of readiness to quit tobacco among patients with oral potentially malignant disorders using transtheoretical model.

BACKGROUND:Tobacco use is a disease of addiction and a behavior choice. It is valuable to understand the psychosocial dimension of disease.OBJECTIVES:The research aimed to assess the (I) behavioral determinants and pattern of tobacco use (II) readiness to quit tobacco among patients with oral potentially malignant disorders (OPMDs) using transtheoretical model (TTM) approach visiting the dental college in Goa, India.MATERIALS AND METHODS:This cross-sectional analytical study was conducted among 300 patients over 3 months. Information about sociodemographics, determinants including age and reason of onset, behavioral stages, and the presence of OPMDs was collected using specially designed pro forma. Descriptive and inferential statistics were performed using SPSS 18.0.RESULTS:Smokeless form of tobacco 199 (66.34%) was most prevalent followed by smoking 79 (26.33%) and dual tobacco use 22 (07.33%) in males. Majority belonged to low socioeconomic class. Peer influence was the most-cited reason. Around 1/3rd of the participants had OPMDs associated with tobacco use. Significant association was observed between the presence of OPMDs and TTM behavioral stages. Patients with OPMDs are more motivated for tobacco cessation (odd's ratio = 2.30, P = 0.002), that is, they are more in preparation and action stages.CONCLUSION:The findings reflect that smokeless tobacco use is more prevalent in males with low level of education and socioeconomic class. Readiness to quit tobacco increases among patients with OPMDs using TTM.

E-Cigarette Surveillance With Social Media Data: Social Bots, Emerging Topics, and Trends.

BackgroundAs e-cigarette use rapidly increases in popularity, data from online social systems (Twitter, Instagram, Google Web Search) can be used to capture and describe the social and environmental context in which individuals use, perceive, and are marketed this tobacco product. Social media data may serve as a massive focus group where people organically discuss e-cigarettes unprimed by a researcher, without instrument bias, captured in near real time and at low costs.ObjectiveThis study documents e-cigarette–related discussions on Twitter, describing themes of conversations and locations where Twitter users often discuss e-cigarettes, to identify priority areas for e-cigarette education campaigns. Additionally, this study demonstrates the importance of distinguishing between social bots and human users when attempting to understand public health–related behaviors and attitudes.MethodsE-cigarette–related posts on Twitter (N=6,185,153) were collected from December 24, 2016, to April 21, 2017. Techniques drawn from network science were used to determine discussions of e-cigarettes by describing which hashtags co-occur (concept clusters) in a Twitter network. Posts and metadata were used to describe where geographically e-cigarette–related discussions in the United States occurred. Machine learning models were used to distinguish between Twitter posts reflecting attitudes and behaviors of genuine human users from those of social bots. Odds ratios were computed from 2x2 contingency tables to detect if hashtags varied by source (social bot vs human user) using the Fisher exact test to determine statistical significance.ResultsClusters found in the corpus of hashtags from human users included behaviors (eg, #vaping), vaping identity (eg, #vapelife), and vaping community (eg, #vapenation). Additional clusters included products (eg, #eliquids), dual tobacco use (eg, #hookah), and polysubstance use (eg, #marijuana). Clusters found in the corpus of hashtags from social bots included health (eg, #health), smoking cessation (eg, #quitsmoking), and new products (eg, #ismog). Social bots were significantly more likely to post hashtags that referenced smoking cessation and new products compared to human users. The volume of tweets was highest in the Mid-Atlantic (eg, Pennsylvania, New Jersey, Maryland, and New York), followed by the West Coast and Southwest (eg, California, Arizona and Nevada).ConclusionsSocial media data may be used to complement and extend the surveillance of health behaviors including tobacco product use. Public health researchers could harness these data and methods to identify new products or devices. Furthermore, findings from this study demonstrate the importance of distinguishing between Twitter posts from social bots and humans when attempting to understand attitudes and behaviors. Social bots may be used to perpetuate the idea that e-cigarettes are helpful in cessation and to promote new products as they enter the marketplace.