Electronic cigarettes and pregnancy: A social media content analysis.

Objective: Electronic cigarette (e-cigarette) use during pregnancy is a polarizing and complex public health topic. We examined social media content on e-cigarette use during pregnancy.

Methods: We content analyzed 170 TikTok posts about e-cigarettes and pregnancy in 2023. We coded message valence (anti-, pro-, mixed/unclear/neutral), messenger characteristics (age, gender, pregnancy status, healthcare provider status, e-cigarette and cigarette use), geographic origin, and engagement metrics (likes, favorites, shares, downloads, comments, followers). We assessed whether engagement and message valence differed by messenger and post characteristics using Chi-Square and Kruskal-Wallis tests.

Results: Posts included 55 % (n = 93) anti-, 32.4 % (n = 55) mixed/unclear/neutral, and 12.9 % (n = 22) pro-e-cigarette use during pregnancy messages. Messenger characteristics included 90.6 % (n = 144) female, 53.5 % (n = 85) 18 to 30 years old, 40.9 % (n = 65) pregnant, 7.5 % (n = 12) healthcare providers. Geographic origin included 66.5 % (n = 113) from the United States and 22.9 % (n = 39) from the United Kingdom. Engagement was high, with some videos receiving over 2 million "plays" and 500 thousand "likes." Posts by healthcare providers and messengers over 45 years old had more followers (ps < 0.001). Posts with messengers who quit e-cigarettes, from the US, and 18-45 years old were more likely to contain anti-e-cigarette content, whereas posts from the United Kingdom were more likely to have pro-e-cigarette content (ps ≤ 0.001).

Conclusions: A wide range of content on e-cigarette use and pregnancy was observed on TikTok. Future research is needed to understand how pregnant individuals navigate this content. Healthcare providers may be effective messengers for promoting e-cigarette cessation during pregnancy on social media.