The public health sector is clearly divided about the use of e-cigarettes. E-cigarette proponents promote the devices as an integral policy solution for reducing smoking prevalence. By contrast, Australian leading health authorities have noted the documented harms associated with e-cigarette use, the growing evidence linking use with smoking initiation among youth, and the insufficient evidence on the efficacy of e-cigarettes as smoking cessation aids. On this basis, they have adopted a precautionary approach, as recommended by the World Health Organization, and called for (a) urgent efforts to reduce the accessibility of e-cigarettes and (b) the continued promotion of only those cessation therapies that have been independently tested for efficacy and safety.
Given claims made about e-cigarettes on social media platforms have the potential to influence the decisions of consumers and policymakers, an examination of the information being disseminated is warranted. Accordingly, the present study sought to explore the claims being made by Australian proponents of e-cigarettes via their Twitter feeds.
Experts in tobacco control policy and practice from three leading Australian public health agencies were approached by email and asked to identify proponents of e-cigarettes in Australia who are also prolific providers of social media commentary related to these devices. The experts identified five proponents meeting these criteria: four individuals (all of whom are medical practitioners) and one organisation. Proponents are unable to be named or directly quoted due to the anonymity conditions required by the Human Research Ethics Committee that approved this research.
Tobacco control activists – not named in the research (why?) – were asked to nominate their ideological enemies – who cannot be named (why?).
These individuals (and one organisation) were then cyberstalked.
Nearly a third of tweets (29%) criticised the arguments made by various public health agencies and/or individual advocates opposed to the use and legalisation of e-cigarettes.
The general sentiment of these tweets was that the precautionary principle adopted by these agencies/advocates was ineffective compared to a harm reduction approach.
Many of these tweets suggested that the position of public health agencies/advocates lacks an appropriate evidence base and hence they were (a) fabricating and/or exaggerating the risks of e-cigarette use, (b) denying and/or ignoring the benefits of e-cigarette use and/or (c) making nonsensical and weak arguments based on low-quality evidence at the cost of smokers’ health and lives.
Calls to legalise e-cigarettes featured in a fifth of tweets (18%). These tweets typically argued that legalisation would facilitate smoking cessation and reduce smoking rates and smoking-related harm and deaths in Australia. For example, many of the tweets claimed that the ban on e-cigarettes made it easier for smokers to continue smoking and/or harder for smokers to quit, with anecdotes used in some tweets to support these claims. It was also claimed that the ban on e-cigarettes was contributing to a plateau in the decline of smoking rates in Australia, while smoking prevalence is declining at an accelerated rate in countries where e-cigarette use is legal.
The extent to which proponents advocated for the legalisation of e-cigarettes is problematic as it has the potential to create an impression that there is greater opposition to current policy and more widespread support for policy change than really exists. Ongoing surveillance of the extent to which Australian proponents are calling for the legalisation of e-cigarettes, and the evidence being used to legitimise these calls, should be an important component of public health and policy agendas, especially given social media activity has the potential to be an effective means of influencing public policy.
The results of the present study indicate that Australian proponents of e-cigarettes are using their Twitter accounts to (a) criticise the evidence-based [sic] claims of public health agencies and advocates opposed to the devices and (b) influence public policy by advocating heavily for the legalisation of e-cigarettes. Ongoing surveillance of the tweets of e-cigarette proponents in Australia and efforts to minimise their reach should be included in strategies to curtail increasing use of e-cigarettes in this country.
I’m actually surprised that a university ethics committee has signed off on a project that involves anonymity on this scale, cyberstalking (x2), and ends with calls for public censorship. Four of the authors appear to be employed by universities – and calls to censor their twitter feeds would be a violation of their academic freedom.
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