Social media is a new battlefield in tobacco vs anti-tobacco war [1]. At K-message we took a look at the recent research to put some light on the tactics and efficiency of social media activities of tobacco industry and tobacco control campaigners.
Exposure to Tobacco in Social Media Impacts Smoking Behavior.
Before assessing activity of tobacco marketing in social media, we need to establish whether there is any significant link between exposure to tobacco related content in social media and real-life smoking behavior.
Recently published study on representative group of 200 young adults in Connecticut confirmed that encoded exposure to social media tobacco depictions indeed is a significant predictor of smoking. In fact social media influence seems to be above the influence of TV and movie depictions of smoking.[2]
Tobacco Advertising and Promotion in Social Media Targets Youth
Youth is a crucial target audience for both tobacco marketing and anti-tobacco campaigns. According to the research tobacco advertising reaches via social media 11% of youth. Tobacco promotion exposure via social media was associated with an increased positive attitudes towards tobacco smoking.[3]
Tobacco Advertising and Promotion in Social Media – Marketing Activity Overview.
Social media is a potent commercial channel used by many industries. One of the effects of anti-tobacco regulations was a push for innovation in tobacco marketing. One of the recent attempts to establish an overview of tobacco marketing activities in social media has analysed set of 70 popular cigarette brands segmented into two groups by their retail prices. The search has been conducted across Facebook, YouTube and Wikipedia using brand names as keywords.
According to the data collected from March 3, 2014 to March 10, 2014, 43 of the 70 representative cigarette brands had created 238 Facebook fan pages, 46 cigarette brands were identified in Wikipedia, and there were over 120,000 pro-tobacco videos on YouTube, associated with 61 cigarette brands.
The content differs by social media channel, but interestingly not by price segment of the brand.
| Social Media Channel | Preferred Content Type |
| Wikipedia | History, cultural context of the brand |
| History, cultural context, major products | |
| YouTube | Features of major products, online shopping |
Sales promotion is more prevalent on YouTube, and more prevalent for higher retail cost brands. YouTube was the most used channel (61 brands), Wikipedia covered 48 brands, Facebook 43 brands.[4]
Figure 1. Statistical features of tobacco brands on Facebook.
The numbered ring indicates how many fan pages are named after the given cigarette brand. For example, 43 fan pages are named after Gold Flake; while Camel, Dunhill, Gauloises, and Pall Mall closely follow with over 10 fan pages. Pertaining to page likes, Lucky Strike overwhelms other brands with, in total, 172,862 page likes on 9 fan pages. Dunhill, Black Devil, and Camel are also popular cigarette brands with 120,696, 63,758, and 44,355 Facebook page likes respectively. In terms of post volume, Gold Flake, Lucky Strike, and Dunhill are the top 3 brands with 2981, 2651, and 2592 posts respectively.
Copyright ©Yunji Liang, Xiaolong Zheng, Daniel Dajun Zeng, Xingshe Zhou, Scott James Leischow, Wingyan Chung. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 21.01.2015. CC-BY-2.0
Tobacco-related Social Networks and User Generated Content
Outside of “officialy” owned pro and anti tobacco marketing content, social media channels include tobacco related content generated by users in their social networks. In a recent study researchers analyzed those tobacco related networks.
The analysis has shown significant differences between pro-tobacco and anti-tobacco or tobacco cessation networks in their size and interaction patterns. First of all, networks promoting tobacco on Facebook contain more than half of all tobacco-related dataset.
Figure 2: Statistical Patterns of Page Features in three tobacco communities.
Copyright ©Yunji Liang, Xiaolong Zheng, Daniel Dajun Zeng, Xingshe Zhou, Scott James Leischow, Wingyan Chung. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 21.01.2015. CC-BY-2.0
- Most of Anti- and Quitting tobacco Pages have approx 32 followers
- Pro-Tobacco Pages have approximately 1000 followers
- Pro-Tobacco Pages are more effective in gaining user attention/interaction
- Over 70% of anti and quitting tobacco pages have less than 10 comments
- In pro-tobacco it is only 56% pages that have less than 10 comments
Figure 3: Distribution of Response Time in Tobacco communities.
Copyright ©Yunji Liang, Xiaolong Zheng, Daniel Dajun Zeng, Xingshe Zhou, Scott James Leischow, Wingyan Chung. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 21.01.2015. CC-BY-2.0
90% of user comments happened within less than 330 hours for pro-tobacco community; that is 197 hours for tobacco control and 213 hours for tobacco cessation respectively. This indicates that the posts in pro-tobacco community have long-lasting effects for online interaction.
Of the top 35 influential tobacco-related fan pages, 43% are conducting tobacco promotion. According to the research, the pro-tobacco pages are using a set of different strategies.
‘AnimalsSmokingDurrys’ and ‘GirlsSmoking’ are examples of using fetish imagery (images of young men and women smoking, smoking sexual fetish scenarios, smoking animals or cartoon characters etc.) to promote smoking as cool, fashion or fun.
Online tobacco shops such as ‘smokefreeonline’ and ‘hookah-shisha’ and tobacco retailers (‘mrhookah’ and ‘bnbtobacco’) create fan pages with embedded URLs of online tobacco shops, focusing on sales promotion.
Fan pages named after tobacco brands such as ‘EcoDumas.lt’ and ‘espinosacigars’ are established for tobacco brand campaign.
On the other hand, the social media is utilized for tobacco control and tobacco cessation as well. Many regional organizations such as ‘TobaccoFreeFlorida’ and ‘TobaccoFreeCA’ were created for tobacco free campaigns. Furthermore, some tobacco cessation services are provided to help smokers to quit smoking. ‘BecomeAnEX’ is a very famous community to help the smokers by facts, therapy and experience sharing.[5]
Anti-Tobacco Campaigns in Social Media
Anti-tobacco campaigns are also visible in Social Media, even if their efficiency seems to be lower than those promoting tobacco. While tobacco industry efforts in this field are often analyzed, the other side is often forgotten, maybe because of low efficiency of its efforts.
A good example of this low efficiency is shown in the study of social media use by state tobacco control programs (TCPs) to promote smoking cessation.
In 2013, 60% (30/50) of TCPs were using social media. Overall, 60% (30/50) had a Facebook page, 36% (18/50) had a Twitter page, and 40% (20/50) had a YouTube channel. The reach of social media was different across each site and varied widely by state. Among TCPs with a Facebook page, 73% (22/30) had less than 100 likes per 100,000 adults in the state, and 13% (4/30) had more than 400 likes per 100,000 adults. Among TCPs with a Twitter page, 61% (11/18) had less than 10 followers per 100,000 adults, and just 1 state had more than 100 followers per 100,000 adults.[6]
Below we have listed three anti tobacco social media use cases that may show a way to increase social media impact of tobacco control side.
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Anti-tobacco social media use case 1. ShishAware.
There are also interesting and well researched case studies of anti tobacco campaigns in social media. The first which we would like to describe was “ShishAware” a public health campaign to raise awareness of waterpipe tobacco smoking health effects. Waterpipe, known also as nargileh, hookah or shisha is traditional to Middle East and South Asia. It is increasingly popular among young adults of Middle East origin in Western countries, including UK. Among high school students in London, the prevalence of waterpipe tobacco smoking was over double that of cigarette smoking (7.6% versus 3.4%), whereas in the US national reports suggest 2.6% of adolescents are current waterpipe users.
Waterpipe tobacco smoking is significantly associated with lung cancer, respiratory illness, low birth weight, and periodontal disease. There are also possible associations with bladder cancer, nasopharyngeal cancer, oesophageal cancer, oral dysplasia, and infertility [7,8], which are expected in lieu of the high level of toxicants found in waterpipe tobacco smoke aerosol.[9] In spite of both the proven and suspected deleterious health effects, waterpipe users widely believe it to be less harmful and a safer alternative to cigarette smoking [10, 11]. They believe it contains less nicotine, that the water has filtering properties, and that switching from cigarettes to waterpipe would reduce their health risks. In one study, respondents considered that the lack of media campaigns implies that waterpipe smoking must be safer than cigarette smoking [12] .
The ShishAware campaign relied on three social media (Facebook, Twitter, and YouTube) and a campaign website.
On Facebook, ShishAware posted 130 status updates over nine months (14.4 posts per month), yielding 214 user “likes” and 70 comments. ShishAware had 520 users subscribed at month three, 672 at month six and 776 users at month nine. The majority of users were from the UK (63.9%), male (54.2%), and predominantly aged between 18 and 24 years (63.2%). Sixty-eight and a half percent of status updates had at least one “like”; 23.1% had at least one comment from users. After using an independent samples -test, users were more likely to comment on “shisha facts” than current affairs items (M = 0.29 (SD = 0.70) versus M = 0.10 (SD = 0.31); ).
On Twitter, ShishAware “tweeted” 373 times, averaging 1.4 “tweets”/day. Our longitudinal “tweeting rate” declined over time, from 2.2 “tweets”/day from months 0–3 to 1.1 “tweets”/day from months 3–6 and then to 0.8 “tweets”/day from months 6–9. ShishAware accumulated 563 followers and mainly “tweeted” about current affairs (73.2%). 8.0% of our “tweets” were “retweeted” and nearly two thirds of these (63.0%) were “tweets” mentioning waterpipe tobacco smoking health effects. Other users interacted with ShishAware 70 times (using the notation “@shishaware”), one of which was from a journalist that interviewed ShishAware in person and broadcast the interview on a Somali satellite channel.
On YouTube, ShishAware’s video accumulated 7,041 views in six months, and by nine months it had gained 19,428 views. At nine months it gained 69 “likes,” 67 “dislikes,” and 218 comments (112.2 comments/10,000 views) (not including ShishAware’s comments), 188 (86%) of which were from pro-waterpipe tobacco smoking individuals. It was also “favourited” by 28 users. YouTube statistics revealed that 76% of viewers were male, and 41% were aged 18 to 34 years, and viewers were from all world continents.[13]
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Anti-tobacco social media use case 2. Picture Me Smokefree
Picture Me Smokefree is an online tobacco reduction and cessation intervention for young adults that uses digital photography and social networking.
In Canada, young adults have the highest prevalence of smoking compared to other age groups. Moreover, the prevalence rate almost doubled from adolescence (11%), with an overall smoking rate of 20% for the 20-24 year olds in 2012, according to the findings of the Canadian Tobacco Use Monitoring Survey. Within these subgroups of tobacco users, gender-related differences in smoking were also notable in that they were consistently and significantly higher among young adult men compared to young adult women (23% and 17% for men and women ages 20-24 years, and 27% and 17% for men and women ages 25-34 years). [14]
A total of 60 young adults ages 19-24 years who self-identified as current cigarette smokers or who had quit within the last year were recruited from across British Columbia, Canada, and participated in an online photo group on Facebook over a period of 12 consecutive weeks.
Almost half (25/60, 42%) of the participants reported being daily, light smokers and consuming 5 cigarettes or less per day. Those who were classified as heavier smokers, at between 15-20 cigarettes per day, comprised 15% (9/60) of participants. Like the range in their daily smoking frequency, the length of time participants had smoked varied widely; the most common length of time participants reported having smoked was from 3-5 years.
Additionally, Picture Me Smokefree participants reported that their smoking status changed over the course of the 12 weeks they participated. For example, among the participants who completed the online follow-up survey (39/60), 10% (4/39) reported they had quit during their participation and 51% (20/36) had reduced their smoking during the course of the study. For another 24% (9/36), there were no reported changes, and 5% each (2/39) stated they had relapsed, increased tobacco use, or had already quit prior to the study. Overall smoking status among the women and men recruited was similar: 27% (7/26) of women and 29% (10/34) of men characterized themselves as actively quitting, and 73% (19/26) of women and 71% (24/34) of men were smokers at their sign-up.
Figure: Picture Me Smokefree Facebook landing page.
©Rebecca J Haines-Saah, Mary T Kelly, John L Oliffe, Joan L Bottorff. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.01.2015.
While the campaign was not very successful as cessation help and the study was limited to very small group of participants, it shows that with more effort on recruitment and engaging users could bring good results and the approach is feasible. After all over half of the participants reported reducing their tobacco use. [15]
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Anti-tobacco social media use case 3. Tweet2Quit
Tweet2Quit was a social media intervention for smoking cessation that was delivered online over closed, 20-person quit-smoking groups on Twitter in 100 days.
Social media such as Twitter traditionally involves non-directed peer-to-peer exchanges, but Tweet2Quit hybrid social media intervention sought to increase and direct such exchanges by sending out two types of autocommunications daily: (1) an “automessage” that encouraged group discussion on an evidence-based cessation-related or community-building topic, and (2) individualized “autofeedback” to each participant on their past 24-hour tweeting. The intervention was purposefully designed without an expert group facilitator and with full automation to ensure low cost, easy implementation, and broad scalability. This purely Web-based trial examined two online quit-smoking groups with 20 members each. Participants were adult smokers who were interested in quitting and were recruited using Google AdWords.
Each participant was mailed an 8-week supply of nicotine patches that was dosed per the baseline smoking level (starting with 14 mg patches if <10 cigarettes/day and 21 mg patches if >10 cigarettes/day). Participants were instructed to initiate patch use on their quit date. In addition, participants were referred to the National Institutes of Health online quit-smoking guide to develop a quit plan and were instructed to set a quit date and initiate patch use on their quit date. Clinical practice guidelines recommend combined pharmacological and behavioral treatment to address the physiological and psychological components of nicotine addiction in regular daily smokers. [16]
Overall engagement in the intervention was high with 78% of the group members sending at least one tweet and each member sending an average of 72 tweets. Also 23% of the tweets were in response to the intervention’s automessages. The content of the automessages correlated with the content of the automessage-generated responses, indicating that the automessages largely produced the desired content. On the other hand engagement measured in tweets did not relate or related only marginally to tobacco abstinence. [17]
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Anti-tobacco social media use case 3. Smoking Selfies: Using Instagram to examine smoking behavior.
An interesting approach to social media use in tobacco control has been presented by Glen Szczypka. Over six-month period from June to December 2014 220 smoking behavior and tobacco brand keywords were used to gather 4.1 million image posts on Instagram, an online photo sharing social network.
During the study period, tags with “smoke” or “smoking” generated the most photos, at 2,070,851 and 731,910 respectively. Marlboro was the most popular brand, with 100,452 photos, followed by Lucky Strike, with 17,468. Content of these images was classified as tobacco products, tobacco selfies or smoke clouds. Going forward such monitoring may be used to investigate smoking behavior and social norms among young adults. It also shows how powerful social media are in channeling tobacco advertising content.
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References:
- Liang, Y. et al. Characterizing Social Interaction in Tobacco-Oriented Social Networks: An Empirical Analysis. Sci. Rep. 5, 10060; doi: 10.1038/srep10060 (2015).
- Jacob B. Depue, Brian G. Southwell, Anne E. Betzner, and Barbara M. Walsh (2015) Encoded Exposure to Tobacco Use in Social Media Predicts Subsequent Smoking Behavior. American Journal of Health Promotion: March/April 2015, Vol. 29, No. 4, pp. 259-261.
- Cavazos-Rehg, P. A., Krauss, M. J., Spitznagel, E. L., Grucza, R. A. & Bierut, L. J. The Hazards of new Media: Youth’s exposure to tobacco ads/Promotions. Nicotine Tob. Res. 16, 437–444 (2014).
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- Liang, Y. et al. Characterizing Social Interaction in Tobacco-Oriented Social Networks: An Empirical Analysis. Sci. Rep. 5, 10060; doi: 10.1038/srep10060 (2015).
- Duke JC, Hansen H, Kim AE, Curry L, Allen J. The Use of Social Media by State Tobacco Control Programs to Promote Smoking Cessation: A Cross-Sectional Study; J Med Internet Res 2014;16(7):e169
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- A. Shihadeh, “Investigation of mainstream smoke aerosol of the argileh water pipe,” Food and Chemical Toxicology, vol. 41, no. 1, pp. 143–152, 2003.
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- M. Jawad, S. Jawad, A. Mehdi, A. Sardar, A. M. Jawad, and F. L. Hamilton, “A qualitative analysis among regular waterpipe tobacco smokers in London universities,” International Journal of Tuberculosis and Lung Disease, vol. 17, no. 10, pp. 1364–1369, 2013.
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- Mohammed Jawad, Jooman Abass, Ahmad Hariri, and Elie A. Akl, “Social Media Use for Public Health Campaigning in a Low Resource Setting: The Case of Waterpipe Tobacco Smoking,” BioMed Research International, Article ID 562586, in press.
- Health Canada. [2014-11-05]. Canadian Tobacco Use Monitoring Survey: Supplementary Tables Annual 2012 http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/research-recherche/stat/_ctums-esutc_2012/ann-eng.php.
- Haines-Saah RJ, Kelly MT, Oliffe JL, Bottorff JL. Picture Me Smokefree: A Qualitative Study Using Social Media and Digital Photography to Engage Young Adults in Tobacco Reduction and Cessation. Eysenbach G, ed. Journal of Medical Internet Research. 2015;17(1):e27. doi:10.2196/jmir.4061.
- Fiore MC. Public Health Service. US Department of Health and Human Services; 2008. [2015-02-13]. webcite Treating tobacco use and dependence: 2008 update http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/update/treating_tobacco_use08.pdf.
