https://orcid.org/0000-0002-9718-439X
Abstract
Oral nicotine gum such as LUCY, which comes in colorful packaging, mimicking traditional chewing gum, is becoming popular. Many brands of gum have not been approved by the FDA for smoking cessation. This study examined public discourse about, including sentiment toward, oral nicotine gum on Twitter.
We used Twitter’s Streaming Application Programming Interface to collect data from January 1, 2021, to December 21, 2021, using “nicotine gum” and/or “#nicotinegum” search terms (N = 19 171 unique tweets were collected). We used an inductive approach to become familiar with the data, generated a codebook, and conducted a content analysis on (n = 2152) tweets.
Cessation (n = 716, 33.3%), personal experience (n = 370, 17.2%), and addiction to gum (n = 135, 6.3%) were the most prevalent themes. Cessation tweets primarily discussed cigarette smoking cessation (n = 418, 58.4% of cessation tweets) and successful cessation experiences (n = 155, 21.6%). Other identified themes pertained to using nicotine gum for cognitive enhancement or catching a “buzz” (n = 102, 4.7%), marketing (n = 98, 4.6%), using nicotine gum with other substances (n = 90, 4.2%), and adverse effects (n = 63, 2.9%). Sentiment analysis results revealed that 675 (44.2%) tweets were categorized as neutral, 605 (39.6%) tweets were classified as positive, and 248 tweets (16.2%) were negative.
About one-third of tweets in our corpus mentioned nicotine gum in the context of smoking cessation. Most nicotine gum-related posts conveyed positive and neutral sentiments. Future studies should consider adding novel nicotine gum-specific search terms as well as exploring other social media platforms to gain more insights about these products.
Our findings suggest that Twitter has the potential to track and facilitate conversations between those seeking cigarette cessation advice and those who have successfully quit tobacco by using nicotine gum. Monitoring of promotional content from nicotine gum companies is needed to ensure these products are not appealing to youth and nonusers of tobacco.
Introduction
Nicotine gum products such as Nicorette are currently FDA approved for use as nicotine replacement therapy (NRT) for smoking cessation.1,2 The goal of NRT is to facilitate the transition from cigarette smoking to complete abstinence by replacing the nicotine from the cigarette. NRT helps to reduce nicotine withdrawal symptoms and motivation to smoke.3 NRT is not meant for long-term use and after a few months, the number of doses per day should be slowly reduced until it is no longer required.4
Although FDA-approved nicotine gums have been on the market for decades, newer nicotine gum products (eg, LUCY, Rogue), which are almost indistinguishable from traditional chewing gum, have recently emerged on the US market.5–7 These kinds of nicotine gum come in different flavors (eg, fruit, minty, and sweet) and are marketed as “tobacco-free,” with packaging that bears no resemblance to tobacco products.5,8 While newer oral nicotine gums are similar to FDA-approved products (eg, same levels of nicotine in each unit), they are currently “non-therapeutic” as they lack an evidence base for smoking cessation and are not FDA approved for this purpose.8 Further, newer oral nicotine gums do not come with instructions for tapering the nicotine dose and are marketed as a long-term substitute for combustible cigarettes.5,8 Nevertheless, it is possible that customers are unaware of this distinction and choose these newer products to help with smoking cessation despite the current lack of evidence.
Customers’ perceptions or knowledge of nicotine products are often informed by marketing messages.9,10 Nicotine gum manufacturers have used several marketing strategies that may enhance the perception that these products are low risk (ie, compared to other combustible tobacco products) despite the lack of evidence or proper federal authorization that oral nicotine products (ONPs) are modified-risk tobacco products.11 For example, ONPs are often marketed as “tobacco-free,” and have been described as “less addictive than combustible tobacco.” Claims have been made about how they are beneficial for use as pain relievers, aid in reducing inflammation, and curbing allergy symptoms.5 Nicotine gum has been promoted at point-of-sale locations and online, including social media.5,8
Nontherapeutic nicotine gum brands (eg, LUCY) maintain active social media accounts on Instagram, Twitter, and Facebook.5 Social media is an important tool for studying both the marketing strategies of tobacco brands and public discourse surrounding new and emerging tobacco products, including ONPs. Research on the contexts and experiences associated with ONP use is limited. Twitter can be used to collect conversations on emerging topics, trends, and products in near real time. As a result, tweets can be quickly captured and analyzed to describe the context of nontherapeutic nicotine gum use, offering new insights into tobacco regulators. In addition, Twitter’s user base encompasses people from various demographics, regions, and interests; it is used by 22% of adults and by 32% of adolescents (aged 13–17 years) in the United States, while 42% of Twitter users are on the platform daily.12,13 This diversity may help reflect the breadth of sentiment toward, and experiences with, oral nicotine gum products among the public. The purpose of our study was to document and analyze discussions on Twitter about the public’s experiences with nicotine gum, including gaining an understanding of the context (ie, for cessation, cognitive enhancement, etc.) in which these products are used.
Methods
Posts containing the terms “nicotine gum” and/or “#nicotinegum” were collected from January 1, 2021, to December 21, 2021, from Twitter’s Streaming Application Programming Interface. The initial corpus consisted of n = 19 171 unique posts (excluding re-tweets). Similar to prior research, we randomly selected a subset of n = 5000 posts for the content analysis.14,15 Two coders (EG and AS) worked together with the first (AG) and last authors (JBU) to become familiar with the data, created a codebook, and coded tweets into themes using an inductive approach. The goal of this approach was to condense the tweets into a summary format and report the fundamental themes evident in the data. The text of the tweet was the unit of analysis.
To appreciate the breadth of the conversation and to avoid weighting the sample with echoes of identical statements, we removed redundant posts from the analytical sample. Redundant nicotine gum-related posts were defined as partial/entire reposts (copy–paste) of someone else’s original tweet with altered account mentions (eg, @person) and/or hashtags (eg, #hashtag). For instance, many posts (that were determined redundant) reposted the following: “E-cigarettes are better smoking cessation tool than nicotine gum! Deadly news: politicians are banning e-cigarettes in India.” After excluding redundant (n = 2836) and non-English posts (n = 12), we were left with (n = 2152) tweets for the content analysis or 43.1% of the randomly sampled subset of tweets and 11.2% of the initial corpus.
The codebook (Table 1) consisted of the following themes: (1) Cessation (divided into the following three subcategories: (a) Combustible Cigarette Smoking Cessation, (b) Vaping Cessation, and (c) Successful Cessation Experience); (2) Using for cognitive enhancement or to catch a “buzz”; (3) Addicted to nicotine gum; (4) Policy; (5) Personal; (6) Marketing; (7) Price; (8) Adverse effects; (9) Flavor/Taste; (10) Using with other substances; (11) Nontherapeutic nicotine gum brands (eg, LUCY); (12) Other. A tweet could be classified into multiple themes. In addition, we conducted a sentiment analysis and classified n = 1529 tweets (all posts except those coded as “other”) into three categories: positive, negative, and neutral.9,16 We defined positive tweets as those that expressed a positive experience with, or favorable opinion about (eg, love, like) nicotine gums. Negative tweets were those that expressed a negative experience with or negative opinion about (eg, hate, dislike) nicotine gums. Neutral tweets were those that expressed neither positive nor negative sentiments. To establish interrater reliability, two authors double coded a subsample of posts (n = 400), with percent agreement ranging from 92.8% to 100%, and Cohen’s kappa ranging from 0.57 to 1.00. The first and last authors served as arbitrators to resolve discrepancies between the coders.
Definition for Each Theme, Descriptive Statistics, and Selected Paraphrased Twitter Posts (N = 2152)
| Theme | N (%) | Definition | Paraphrased post |
|---|---|---|---|
| 1. Cessation | 716 (33.3) | Mentions of cessation attempts. | “I smoked for many years. Took a lot of tires and nicotine gum. Good luck!” |
| a. Combustible cigarette smoking cessation | 418 (19.4) | Mentions of using nicotine gums for tobacco smoking cessation. | “@xxx or quit cigarettes by using nicotine gum.” |
| b. Vaping cessation | 59 (2.7) | Mentions of using nicotine gums for vaping cessation. | “I bought some nicotine gum to quit JUUL today. Wish me good luck.” |
| c. Successfully cessation experience | 155 (7.2) | Mentions of successful quit attempts by using nicotine gum. | “I have not used cigarettes for over 25 years now. Nicotine gum helped me to quit.” |
| 2. Using for cognitive enhancement and/or to catch a “buzz” | 102 (4.7) | Mentions of using nicotine gums for cognitive enhancement and/or improving mental health, to “catch a buzz,” an “energy hit,” and/or to get more nicotine. | “A lot of people use nicotine gum to stay focused. It is pretty good.” |
| 3. Addicted to gum | 135 (6.3) | Mentions of nicotine gum being addictive or unable to quit nicotine gum. | “I have been using nicotine gum for over 6 years. I can’t stop using it” |
| 4. Policy | 45 (2.1) | Mentions of nicotine gum and some form of tobacco policy or regulation. | “This is ridiculous. They are legalizing cannabis, but you must be 21 to buy nicotine gum.” |
| 5. Personal experience | 370 (17.2) | Posts containing a description of personal use of, or opinion about nicotine gums. | “Nicotine gum works.” |
| 6. Marketing | 98 (4.6) | Posts promoting/selling/marketing nicotine gums. | “Cinnamon Nicorette Nicotine Gum, 4mg. 200 Count. https://xxx...” |
| 7. Price | 33 (1.5) | Mentions of nicotine gum price (eg, more expensive than cigarettes or vapes). | “Smoking is cheaper than using nicotine gum.” |
| 8. Adverse effects | 63 (2.9) | Mentions of adverse effects associated with nicotine gum use. | “I just tried a nicotine gum, and I got so sick . . .” |
| 9. Flavor/taste | 133 (6.2) | Mentions of nicotine gum flavors (eg, fruit, cinnamon, mint) or taste. | “I found cinnamon flavored nicotine gum to taste pretty good.” |
| 10. Using nicotine gum with other substances | 90 (4.2) | Mentions of using nicotine gums in combination with cigarettes, marijuana, caffeine, and/or other substances | “I smoke a cigarette and use nicotine gum at the same time.” |
| 11. Newer nontherapeutic nicotine gum brands | 16 (0.7) | Mentions of novel nontherapeutic oral nicotine gum products (eg, LUCY). | “I heard Lucy nicotine gum is the best.” |
| 12. Other | 623 (29.0) | Any other posts that contain oral nicotine gum themes and not fit into any category listed in the codebook. | “How about nicotine gum?” |
| Theme | N (%) | Definition | Paraphrased post |
|---|---|---|---|
| 1. Cessation | 716 (33.3) | Mentions of cessation attempts. | “I smoked for many years. Took a lot of tires and nicotine gum. Good luck!” |
| a. Combustible cigarette smoking cessation | 418 (19.4) | Mentions of using nicotine gums for tobacco smoking cessation. | “@xxx or quit cigarettes by using nicotine gum.” |
| b. Vaping cessation | 59 (2.7) | Mentions of using nicotine gums for vaping cessation. | “I bought some nicotine gum to quit JUUL today. Wish me good luck.” |
| c. Successfully cessation experience | 155 (7.2) | Mentions of successful quit attempts by using nicotine gum. | “I have not used cigarettes for over 25 years now. Nicotine gum helped me to quit.” |
| 2. Using for cognitive enhancement and/or to catch a “buzz” | 102 (4.7) | Mentions of using nicotine gums for cognitive enhancement and/or improving mental health, to “catch a buzz,” an “energy hit,” and/or to get more nicotine. | “A lot of people use nicotine gum to stay focused. It is pretty good.” |
| 3. Addicted to gum | 135 (6.3) | Mentions of nicotine gum being addictive or unable to quit nicotine gum. | “I have been using nicotine gum for over 6 years. I can’t stop using it” |
| 4. Policy | 45 (2.1) | Mentions of nicotine gum and some form of tobacco policy or regulation. | “This is ridiculous. They are legalizing cannabis, but you must be 21 to buy nicotine gum.” |
| 5. Personal experience | 370 (17.2) | Posts containing a description of personal use of, or opinion about nicotine gums. | “Nicotine gum works.” |
| 6. Marketing | 98 (4.6) | Posts promoting/selling/marketing nicotine gums. | “Cinnamon Nicorette Nicotine Gum, 4mg. 200 Count. https://xxx...” |
| 7. Price | 33 (1.5) | Mentions of nicotine gum price (eg, more expensive than cigarettes or vapes). | “Smoking is cheaper than using nicotine gum.” |
| 8. Adverse effects | 63 (2.9) | Mentions of adverse effects associated with nicotine gum use. | “I just tried a nicotine gum, and I got so sick . . .” |
| 9. Flavor/taste | 133 (6.2) | Mentions of nicotine gum flavors (eg, fruit, cinnamon, mint) or taste. | “I found cinnamon flavored nicotine gum to taste pretty good.” |
| 10. Using nicotine gum with other substances | 90 (4.2) | Mentions of using nicotine gums in combination with cigarettes, marijuana, caffeine, and/or other substances | “I smoke a cigarette and use nicotine gum at the same time.” |
| 11. Newer nontherapeutic nicotine gum brands | 16 (0.7) | Mentions of novel nontherapeutic oral nicotine gum products (eg, LUCY). | “I heard Lucy nicotine gum is the best.” |
| 12. Other | 623 (29.0) | Any other posts that contain oral nicotine gum themes and not fit into any category listed in the codebook. | “How about nicotine gum?” |
Definition for Each Theme, Descriptive Statistics, and Selected Paraphrased Twitter Posts (N = 2152)
| Theme | N (%) | Definition | Paraphrased post |
|---|---|---|---|
| 1. Cessation | 716 (33.3) | Mentions of cessation attempts. | “I smoked for many years. Took a lot of tires and nicotine gum. Good luck!” |
| a. Combustible cigarette smoking cessation | 418 (19.4) | Mentions of using nicotine gums for tobacco smoking cessation. | “@xxx or quit cigarettes by using nicotine gum.” |
| b. Vaping cessation | 59 (2.7) | Mentions of using nicotine gums for vaping cessation. | “I bought some nicotine gum to quit JUUL today. Wish me good luck.” |
| c. Successfully cessation experience | 155 (7.2) | Mentions of successful quit attempts by using nicotine gum. | “I have not used cigarettes for over 25 years now. Nicotine gum helped me to quit.” |
| 2. Using for cognitive enhancement and/or to catch a “buzz” | 102 (4.7) | Mentions of using nicotine gums for cognitive enhancement and/or improving mental health, to “catch a buzz,” an “energy hit,” and/or to get more nicotine. | “A lot of people use nicotine gum to stay focused. It is pretty good.” |
| 3. Addicted to gum | 135 (6.3) | Mentions of nicotine gum being addictive or unable to quit nicotine gum. | “I have been using nicotine gum for over 6 years. I can’t stop using it” |
| 4. Policy | 45 (2.1) | Mentions of nicotine gum and some form of tobacco policy or regulation. | “This is ridiculous. They are legalizing cannabis, but you must be 21 to buy nicotine gum.” |
| 5. Personal experience | 370 (17.2) | Posts containing a description of personal use of, or opinion about nicotine gums. | “Nicotine gum works.” |
| 6. Marketing | 98 (4.6) | Posts promoting/selling/marketing nicotine gums. | “Cinnamon Nicorette Nicotine Gum, 4mg. 200 Count. https://xxx...” |
| 7. Price | 33 (1.5) | Mentions of nicotine gum price (eg, more expensive than cigarettes or vapes). | “Smoking is cheaper than using nicotine gum.” |
| 8. Adverse effects | 63 (2.9) | Mentions of adverse effects associated with nicotine gum use. | “I just tried a nicotine gum, and I got so sick . . .” |
| 9. Flavor/taste | 133 (6.2) | Mentions of nicotine gum flavors (eg, fruit, cinnamon, mint) or taste. | “I found cinnamon flavored nicotine gum to taste pretty good.” |
| 10. Using nicotine gum with other substances | 90 (4.2) | Mentions of using nicotine gums in combination with cigarettes, marijuana, caffeine, and/or other substances | “I smoke a cigarette and use nicotine gum at the same time.” |
| 11. Newer nontherapeutic nicotine gum brands | 16 (0.7) | Mentions of novel nontherapeutic oral nicotine gum products (eg, LUCY). | “I heard Lucy nicotine gum is the best.” |
| 12. Other | 623 (29.0) | Any other posts that contain oral nicotine gum themes and not fit into any category listed in the codebook. | “How about nicotine gum?” |
| Theme | N (%) | Definition | Paraphrased post |
|---|---|---|---|
| 1. Cessation | 716 (33.3) | Mentions of cessation attempts. | “I smoked for many years. Took a lot of tires and nicotine gum. Good luck!” |
| a. Combustible cigarette smoking cessation | 418 (19.4) | Mentions of using nicotine gums for tobacco smoking cessation. | “@xxx or quit cigarettes by using nicotine gum.” |
| b. Vaping cessation | 59 (2.7) | Mentions of using nicotine gums for vaping cessation. | “I bought some nicotine gum to quit JUUL today. Wish me good luck.” |
| c. Successfully cessation experience | 155 (7.2) | Mentions of successful quit attempts by using nicotine gum. | “I have not used cigarettes for over 25 years now. Nicotine gum helped me to quit.” |
| 2. Using for cognitive enhancement and/or to catch a “buzz” | 102 (4.7) | Mentions of using nicotine gums for cognitive enhancement and/or improving mental health, to “catch a buzz,” an “energy hit,” and/or to get more nicotine. | “A lot of people use nicotine gum to stay focused. It is pretty good.” |
| 3. Addicted to gum | 135 (6.3) | Mentions of nicotine gum being addictive or unable to quit nicotine gum. | “I have been using nicotine gum for over 6 years. I can’t stop using it” |
| 4. Policy | 45 (2.1) | Mentions of nicotine gum and some form of tobacco policy or regulation. | “This is ridiculous. They are legalizing cannabis, but you must be 21 to buy nicotine gum.” |
| 5. Personal experience | 370 (17.2) | Posts containing a description of personal use of, or opinion about nicotine gums. | “Nicotine gum works.” |
| 6. Marketing | 98 (4.6) | Posts promoting/selling/marketing nicotine gums. | “Cinnamon Nicorette Nicotine Gum, 4mg. 200 Count. https://xxx...” |
| 7. Price | 33 (1.5) | Mentions of nicotine gum price (eg, more expensive than cigarettes or vapes). | “Smoking is cheaper than using nicotine gum.” |
| 8. Adverse effects | 63 (2.9) | Mentions of adverse effects associated with nicotine gum use. | “I just tried a nicotine gum, and I got so sick . . .” |
| 9. Flavor/taste | 133 (6.2) | Mentions of nicotine gum flavors (eg, fruit, cinnamon, mint) or taste. | “I found cinnamon flavored nicotine gum to taste pretty good.” |
| 10. Using nicotine gum with other substances | 90 (4.2) | Mentions of using nicotine gums in combination with cigarettes, marijuana, caffeine, and/or other substances | “I smoke a cigarette and use nicotine gum at the same time.” |
| 11. Newer nontherapeutic nicotine gum brands | 16 (0.7) | Mentions of novel nontherapeutic oral nicotine gum products (eg, LUCY). | “I heard Lucy nicotine gum is the best.” |
| 12. Other | 623 (29.0) | Any other posts that contain oral nicotine gum themes and not fit into any category listed in the codebook. | “How about nicotine gum?” |
Data Analysis
Descriptive analyses were conducted to show the prevalence of each theme. To visualize the change in the percentage of themes over time, data were plotted across the study period (from January 2021 to December 2021). All Twitter posts in this dataset were publicly available and anonymized, and all analyses adhered to the terms and conditions, terms of use, and privacy policies of Twitter. To further protect privacy, tweets exemplifying themes were paraphrased; no tweets were reported verbatim. The protocol was approved by the university’s institutional review board.
Results
The codebook and example paraphrased tweets are reported in Table 1. Figure 1 (left panel) shows the distribution of analyzed tweets (n = 2152) by month. Overall, the most prevalent themes were Cessation (716/2,152; 33.3%), Personal Experience (370/2,152; 17.2%), Addicted to Gum (135/2,152; 6.3%), and Flavor/taste (133/2,152; 6.2%). Cessation tweets primarily discussed Combustible Cigarette Smoking Cessation (418/716; 58.4%), Successful Cessation Experience (155/716; 21.6%), or Vaping Cessation (59/716; 8.2%).
Left panel: Total tweet counts (n = 2152) by month. Right panel: The percentage of tweets containing the selected themes (marketing, policy, flavor/taste) by month.
Other themes had relatively lower prevalence in the sample: Using for cognitive enhancement or to catch a “buzz” (102/2,152; 4.7%), Marketing (98/2,152; 4.6%), Using nicotine gum with other substances (90/2,152; 4.2%), Adverse effects (63/2,152; 2.9%), Policy (45/2,152; 2.1%), and Price (33/2,152; 1.5%). Mentions of Nontherapeutic nicotine gum brands (eg, LUCY) were uncommon (16/2,152; 0.7%). Most tweets were classified as positive (605 [39.6%]) or neutral (675 [44.2%]), while 248 (16.2%) tweets were classified as negative.
Figure 1 (right panel) shows the percentage of tweets containing the selected themes (those that varied over time) as a function of month. The proportion of tweets containing Marketing and Flavor/taste themes was greatest in March 2021 and decreased toward the end of the study period (December 2021). The prevalence of tweets with the Policy theme gradually increased in August–September and peaked in October 2021. Proportions of all other themes remained relatively stable over time.
Discussion
This study summarized public Twitter posts about oral nicotine gum collected over the course of 12 months. Tweets in our corpus were about the use of nicotine gum to quit other tobacco products, personal experience using nicotine gum, mentions of being addicted to nicotine gum, and mentions of the flavor or taste of oral nicotine gum. Smoking cessation was the most prevalent subtheme among cessation posts. Overall, we found that most nicotine gum-related posts on Twitter conveyed positive and neutral sentiments. The use of brand names such as LUCY and Rogue did not often co-occur with “nicotine gum” and/or “#nicotinegum” in tweets.
Cessation was the most prevalent theme in this study, while smoking cessation and tweets describing successful quit attempts by using nicotine gum were common subthemes. Some FDA-approved nicotine gum (eg, Nicorette) have been shown to be safe and effective in helping smokers quit combustible cigarettes; hence, it is unsurprising that the majority of tweets in the analyzed corpus focused on cessation-related topics.1,2 Nonetheless, most posts in our corpus did not include the nicotine gum brand names; thus, it is unclear whether Twitter users were referring to FDA-approved gum or novel nicotine gum products (such as LUCY and Rogue).
Previous research has demonstrated that placing ready-to-quit smokers in a Twitter support group fostered community building and provided an outlet for participants to discuss the usage of cessation products, obstacles, and personal feelings in regard to quitting nicotine products.17 Our findings suggest that social media platforms such as Twitter have the potential to track (and potentially facilitate) conversations between those seeking cigarette cessation advice and/or those who have successfully quit cigarettes and other tobacco products by using oral nicotine gum. By providing a platform for these relationships, those who engage in discourse regarding oral nicotine gum can share their experiences and evaluations of cessation products within a community. Interventions could be designed to follow these discussions on Twitter to curate effective cessation methods and evaluate how current cessation products are performing within the market.18
Positive sentiments about nicotine gum were common in our study. Tweets about positive personal experiences may increase readers’ perceptions that nicotine gums are relatively safe and increase positive social norms about these products.6,9,10 Prior research has shown that positive messages about tobacco on Twitter may be linked with tobacco product experimentation.10 Further, the growing popularity of attractive ONPs that are marketed as “smoking alternatives” could lead to confusion among users about which products are evidence-based smoking cessation alternatives.5 Additional U.S. FDA regulations could mandate warning labels acknowledging that nontherapeutic nicotine gums have not been proven to be safer than other tobacco products. These regulations could assist in overcoming misperceptions about novel oral nicotine gum products.
In addition, mentions that nicotine gum is addictive and using nicotine gum to “catch a buzz” and/or for cognitive enhancement were identified as topics in the current study. In small doses, nicotine is a mild stimulant; nonetheless, excessive nicotine consumption may result in nicotine addiction and adverse effects (ie, nausea, vomiting, dizziness, headache, etc.).19,20 Public health campaigns highlighting the harms of using these products for reasons other than combustible tobacco cessation may be beneficial in reducing the incidence of nicotine-related adverse events. Additional regulations that would limit access to nicotine gum products for youth and tobacco nonusers may also help reduce nicotine addiction.
Limitations
This study focused on oral nicotine gum and the findings may not pertain to other ONPs. Our findings may not generalize to nicotine gum users who are not using Twitter. Our findings may not extend to all Twitter users or to the population of the United States. Only two terms (“nicotine gum” and/or “#nicotinegum”) were used to collect data, the inclusion of additional search terms might have identified additional themes in tweets. All posts in this study were from public accounts and may not reflect the attitudes of Twitter users with private accounts. This study focused on the text of the posts but did not code the links or images imbedded in tweets. It is possible that additional themes would have emerged had we coded links or images. Findings may not generalize to other time periods or other social media platforms.
Conclusions
The results of the present study have implications for research and practice. Future studies should consider adding novel nicotine gum-specific search terms as well as exploring other social media platforms to gain more insights about these products. While nicotine gum is a popular ONP, other commercial products such as pouches and lozenges are growing in popularity.6 Clinical trials evaluating the safety and effectiveness of nicotine gum for smoking cessation are warranted. Moreover, the ways in which these products are used and adapted should be documented (ie, use in combination with other combustible tobacco products, and in duration). Closer monitoring of promotional content from nicotine gum companies are needed to ensure these products are not appealing to youth and nonusers of tobacco.
Supplementary Material
A Contributorship Form detailing each author’s specific involvement with this content, as well as any supplementary data, are available online at https://academic.oup.com/ntr.
Funding
Research reported in this publication was supported by a National Cancer Institute (NCI) and FDA Center for Tobacco Products Award (NCI/FDA Grant #U54CA180905). NCI or the FDA had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Declaration of Interests
JPA has received fees for consulting services in court cases pertaining to the content on social media platforms. He reports no other conflicts of interest. All other authors declare no competing interests. The authors alone are responsible for the content and writing of this paper.
Author Contributions
Artur Galimov (Conceptualization [Equal], Data curation [Equal], Formal analysis [Lead], Investigation [Supporting], Methodology [Lead], Visualization [Lead], Writing—original draft [Lead], Writing—review & editing [Lead]), Matthew Kirkpatrick (Conceptualization [Supporting], Formal analysis [Supporting], Methodology [Supporting], Supervision [Equal], Writing—original draft [Supporting], Writing—review & editing [Equal]), Julia Vassey (Formal analysis [Supporting], Visualization [Supporting], Writing—original draft [Supporting], Writing—review & editing [Supporting]), Ellen Galstyan (Investigation [Equal], Writing—original draft [Supporting], Writing—review & editing [Supporting]), Ashley Smith (Investigation [Equal], Writing—original draft [Supporting], Writing—review & editing [Supporting]), Jon-Patrick Allem (Data curation [Supporting], Formal analysis [Supporting], Funding acquisition [Equal], Methodology [Supporting], Project administration [Equal], Resources [Equal], Supervision [Equal], Validation [Equal], Writing—review & editing [Equal]), and Jennifer Unger (Conceptualization [Equal], Data curation [Supporting], Formal analysis [Supporting], Funding acquisition [Equal], Methodology [Supporting], Project administration [Equal], Resources [Equal], Supervision [Equal], Validation [Equal], Writing—review & editing [Equal])
Data Availability
Data will be made available upon reasonable request to corresponding author.
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