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Examining Cannabis, Tobacco, and Vaping Discourse on Reddit: An Exploratory Approach Using Natural Language Processing

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Associated Data

The datasets presented in this article are not readily available because this dataset contains social media usernames which if shared, may result in the identification of those individuals. Consequently, this data is not to be shared. Requests to access the datasets should be directed to [email protected]

Abstract

Background: Perceptions of tobacco, cannabis, and electronic nicotine delivery systems (ENDS) are continually evolving in the United States. Exploring these characteristics through user generated text sources may provide novel insights into product use behavior that are challenging to identify using survey-based methods. The objective of this study was to compare the topics frequently discussed among Reddit members in cannabis, tobacco, and ENDS-specific subreddits.

Methods: We collected 643,070 posts on the social media site Reddit between January 2013 and December 2018. We developed and validated an annotation scheme, achieving a high level of agreement among annotators. We then manually coded a subset of 2,630 posts for their content with relation to experiences and use of the three products of interest, and further developed word cloud representations of the words contained in these posts. Finally, we applied Latent Dirichlet Allocation (LDA) topic modeling to the 643,070 posts to identify emerging themes related to cannabis, tobacco, and ENDS products being discussed on Reddit.

Results: Our manual annotation process yielded 2,148 (81.6%) posts that contained a mention(s) of either cannabis, tobacco, or ENDS with 1,537 (71.5%) of these posts mentioning cannabis, 421 (19.5%) mentioning ENDS, and 264 (12.2%) mentioning tobacco. In cannabis-specific subreddits, personal experiences with cannabis, cannabis legislation, health effects of cannabis use, methods and forms of cannabis, and the cultivation of cannabis were commonly discussed topics. The discussion in tobacco-specific subreddits often focused on the discussion of brands and types of combustible tobacco, as well as smoking cessation experiences and advice. In ENDS-specific subreddits, topics often included ENDS accessories and parts, flavors and nicotine solutions, procurement of ENDS, and the use of ENDS for smoking cessation.

Conclusion: Our findings highlight the posting and participation patterns of Reddit members in cannabis, tobacco, and ENDS-specific subreddits and provide novel insights into aspects of personal use regarding these products. These findings complement epidemiologic study designs and highlight the potential of using specific subreddits to explore personal experiences with cannabis, ENDS, and tobacco products.

Keywords: marijuana, tobacco, smoking, electronic cigarettes, social media, natural language processing, Reddit, infodemiology

Introduction

Prior work has explored the broad facets of tobacco, electronic nicotine delivery systems (ENDS), and cannabis. This existing work has focused on various aspects of product use including the use, dual use (i.e., recent use of two product types), co-use (i.e., the simultaneous use of two product types), and user opinions of these different products (1–4). Furthermore, survey data has suggested that individuals frequently co-use these products, warranting the study of these products together rather than separately (5). Using consumer-generated data—in this context, textual data derived from social media services like Twitter and Reddit—continues to gain traction as a method to generate new insights into product use behavior. Using such approaches to study tobacco, ENDS, and cannabis could provide novel firsthand accounts on the use of these products and serve to complement existing survey-based approaches to study their use.

Tobacco Use in the United States

Since the release of the first US Surgeon General’s report in 1964, the prevalence of combustible tobacco use has substantially declined in the US (6). Although smoking prevalence continues to decline, an estimated 16.7% of the US adult population still currently uses combustible tobacco products, and smoking remains the leading cause of preventable death in the US (6, 7). Combustible tobacco use is associated with a multitude of comorbidities, including but not limited to cardiovascular disease, chronic obstructive pulmonary disease (COPD), and numerous cancers (8). While these health detriments have increased the desire among smokers to quit, the 2015 National Health Interview Survey (NHIS) showed that only 7.4% of past year smoking cessation attempts were successful (9). Combustible tobacco use is more prevalent among males vs. females (20.1 and 13.6% respectively) and individuals between 25 and 44 years of age (7). Additionally, in the US smoking is more common among adults with lower educational attainment, lower-income status, and American Indian/Alaska Native individuals 1 . Developing targeted tobacco cessation strategies among these individuals is a critical step in obtaining the goals outlined by Healthy People 2030 to reduce the prevalence of smoking in the U.S. 2 and, in turn, mortality due to smoking.

ENDS Use in the United States

ENDS or electronic cigarettes, are devices in which a nicotine solution that is often artificially flavored, is heated into a vapor that is then inhaled to simulate the act of smoking. ENDS devices include but are not limited to vape pens (pen-shaped nicotine vaporizers), mods (modifiable nicotine vaporizers), pod-mods (ENDS devices with disposable nicotine pods), and vaporizers (devices with refillable tanks for nicotine solutions) 3 . These devices differ mechanistically and in nicotine delivery, but were initially developed as a cessation aide that resembles the feel and experience of smoking cigarettes (10). Studies have found that the use of ENDS among adult smokers increased the rate of quit attempts and helped those who did attempt to quit achieve a higher rate of sustained abstinence (11–14). In recent years, ENDS use has continually increased, especially among adolescents (15). In 2019, it was estimated that ~4.5% of US adults used an ENDS device, compared to 10.5 and 27.5% of US middle school and high school students, respectively (7, 16). This increase in popularity is largely attributable to the emergence of pod mods, ENDS devices with sleek designs that mimic the nicotinic delivery of combustible cigarettes (17, 18). Although adults commonly use ENDS devices to aid in smoking cessation (6), studies have suggested that adolescents and young adults may be using ENDS devices recreationally rather than to aid smoking cessation (19, 20). Further, a recent study demonstrated that from 2014 to 2018, the adolescent age of initiation for ENDS devices continued to decrease (21), meaning that adolescents were beginning ENDS use at younger ages. These use patterns have sparked great concern about the potential for youth users to develop nicotine dependence, subsequent nicotine addiction, and a later transition to combustible cigarettes (22–24). In addition to the concerns of youth nicotine exposure, the long-term effects of ENDS use have yet to be ascertained, an outcome that can only be observed prospectively with future study.

Cannabis Use in the United States

Cannabis (marijuana) has long been stigmatized as an illicit drug in the US, despite the demonstrated health benefits associated with its use, including pain relief, chronic disease management, and stress reduction (25). However, there is also substantial evidence regarding the potential harms associated with cannabis use. Some of these detrimental health effects include neurological structure alterations, the onset of mental health disorders, cannabis dependency development, and the onset of various chronic conditions (26). From 2002 to 2014, significant increases in cannabis use and initiation were observed among US adults (27). Moreover, following the November 2020 US elections, 19 states and two US territories have now legalized recreational cannabis use and 35 states have legalized medical cannabis 4 , 5 , where states with legalized cannabis tend to show a higher prevalence of use than states without legalized recreational cannabis (28, 29). In addition to the changing legislation surrounding medical and recreational cannabis, the forms and potency of cannabis available on the market continue to change as well. Tetrahydrocannabinol (THC) is the primary psychoactive cannabinoid found in cannabis and the determining compound of cannabis potency. Lab tests of cannabis seized by the Drug Enforcement Administration (DEA) showed that the average THC content had increased 4-fold from 3% in 1980 to 12% in 2012 (30). This high potency, accompanied by the various methods of ingestion (i.e., bud/flower, edibles, topicals, dab pens, extracts) (31), as well as the conflicting evidence regarding the health effects of its use, highlight the critical need for further study of user habits and perceptions of cannabis.

Using Social Media in Public Health Research

For over a decade, the popularity of social media sites continues to rise, as do the functionalities of these sites (e.g., Instagram for posting pictures, Twitter for tweeting short posts, TikTok for posting short videos). Thanks to the development of social media-specific application programming interfaces (APIs), publicly available data posted on these sites can be collected for analysis by end users. As a result, public health researchers have leveraged this available data to study numerous aspects of public health. The research questions that can be explored are largely dependent on the specific site used to obtain data for analysis, as certain social media sites are better suited for specific research questions due to the structure of the website, community posting guidelines put in place, and limits posed by post structure.

Reddit 6 is a popular social media site in which members under a self-chosen username post discussions within a subreddit (i.e., a forum centered around a common theme such as smoking cessation or cannabis use). As a result of this anonymity, members often discuss sensitive and oftentimes stigmatized health behaviors and conditions (32). Furthermore, unlike other social media sites such as Twitter and Facebook, Reddit posts are often more verbose, and since they are aggregated into subreddits centered around common themes of interest, the development of Reddit-specific APIs have resulted in an increasing body of literature leveraging Reddit to study aspects of substance use. Reddit has been used to study the effects of the COVID-19 pandemic on opioid use patterns and disruptions to treatment (33, 34), emerging forms of cannabis discussed in subreddits (35), potential adverse health effects associated with specific JUUL pod flavors (36), and to study linguistic patterns characteristic of alcohol and tobacco abstinence (37), to name a few. Further, we recently published results of natural language processing (NLP) pipelines developed to identify the prevalence of tobacco, cannabis, and ENDS mentions within tobacco, cannabis, and ENDS-related subreddits (38). However, that prior study was primarily concerned with the computational identification of tobacco, cannabis and ENDS mentions in Reddit posts, hence we did not further analyze these posts for the topics discussed within. Therefore, there remains need to investigate the topics of discussion frequent to tobacco, cannabis, and ENDS-centric subreddits.

To address this gap, our study uses qualitative and computational methods to explore member experiences and discussions in eight different subreddits related to cannabis, ENDS, and tobacco product use and to identify differentiating characteristics of these subreddits for assisting with the future study of these products on Reddit. We first explore member-specific experiences as well as general discussion of the three product types by manually annotating posts made in these eight subreddits. Second, we apply Latent Dirichlet Allocation (LDA) topic modeling to our macro-corpus (i.e., posts made in these subreddits over a 5-year span) to determine emerging themes in these posts through an unsupervised manner. Last, we create word clouds for each product (e.g., cannabis, tobacco, and ENDS) based on the vocabulary of our annotated corpus to compare the broad themes discussed in our annotated corpus vs. those topics identified by topic modeling. By understanding the discourse related to these three product types on Reddit, our work serves to identify the use patterns, behaviors, and common topics associated with these products, complementing existing methods for studying differences and similarities in product use behavior.

Methods

Data Collection

There are numerous subreddits focused on cannabis, ENDS, and tobacco, all of which serving a different purpose and with varying levels of member participation. Therefore, we selected a subset of subreddits with at least 50,000 members, demonstrating adequate member engagement within the subreddit, and providing a sufficient sample size to carry out our research objectives. Using the pushshift.io API (39, 40), we downloaded all available data from eight subreddits related to cannabis, ENDS, and tobacco between January 2013 to December 2018. These subreddits consisted of r/Vaping, r/electronic_cigarette, r/Vaping101, r/weed, r/trees, r/Marijuana, r/Cigarettes and r/stopsmoking. Prior work has observed frequent topic drift—a phenomenon where conversation in forums drift from the topic of interest to a different topic, particularly among online forums dedicated to health-related subjects (41). To mitigate topic drift, and in an attempt to observe member-specific experiences and discussion, we only analyzed initiating posts in this study and did not evaluate subsequent comments. Our resulting macro-corpus consisted of 643,070 initiating posts. Figure 1 presents a breakdown of the posts, subsequent comments, and members contained in our macro-corpus. We then stratified the macro-corpus by substance into cannabis-specific subreddits (i.e., r/Marijuana, r/weed, r/trees), tobacco-specific subreddits (i.e., r/stopsmoking, r/Cigarettes), and ENDS-specific subreddits (r/Vaping101, r/Vaping, r/electronic_cigarette). Figure 2 provides the frequency of members participating in subreddits based on product type.

Member and post statistics for macro-corpus, stratified by product type.

Representation of the frequency of members posting in cannabis, tobacco, and ENDS-specific subreddits in our macro-corpus.

Annotation Scheme Development

Before analyzing our Reddit posts, we developed an annotation scheme to capture the various attributes and themes related to Reddit member experiences of ENDS, tobacco, and cannabis. To develop, refine, and evaluate the annotation scheme, we randomly selected a subset of 950 initiating posts from our macro-corpus. Based on prior work (42, 43), we developed an initial list of cannabis, ENDS, and tobacco-related keywords (e.g., tobacco, electronic cigarette, marijuana). As the brand names and terms used to describe tobacco products and cannabis are frequently evolving (35, 44), we used the Gensim Python library (45) to train a neural network-based algorithm, Word2Vec, on the entirety of the macro-corpus to identify additional keywords synonymous or plesionymous (i.e., close to synonymous) to our initial keywords. To ensure that we developed an annotation scheme capturing the attributes of interest (e.g., firsthand use of combustible tobacco, historical cannabis use by someone else) for our study, we filtered posts that did not contain at least one of these keywords of interest. The resulting 280 cannabis, ENDS, and tobacco-related posts were then divided into seven batches for interrater agreement and annotation scheme development. Using the eHost annotation tool (46), authors MH, RB, AC, and MC annotated each batch of posts according to the corresponding version of the annotation scheme. Following each round of annotation, any discrepancies between annotators were discussed, resolved, and an adjudicated annotation set was created. After the seven annotation rounds, the interrater agreement reached an F-score of 0.83, a measure used as a surrogate for Cohen’s Kappa and indicating a strong level of agreement among annotators (47–49). Our final annotation scheme can be found in the Supplementary Material.

Manual Annotation

Having developed and evaluated our annotation scheme, we identified a subset of posts for manual annotation. Due to the observation that some members created initiating posts more frequently than others, and to ensure diversity in the posting patterns represented, we stratified our members into five bins according to the frequency of their initiating posts and selected a random sample of members from each bin. As seen in Figure 3 , 80 members created between 4 and 10 initiating posts, 30 members created between 11 and 50 initiating posts, eight members created between 51 and 100 initiating posts, four members created between 100 and 218 initiating posts, and two members created between 218 and 1,000 initiating posts. Altogether, our sample comprised of 124 Reddit members and their 2,630 initiating posts from the macro-corpus. Author RB annotated the majority of these posts according to the annotation scheme, while author MC annotated a small subset of the posts to ensure the quality of the agreement was maintained. Posts may have contained one or more attributes from our annotation scheme; therefore, annotations are not necessarily mutually exclusive. The resulting proportions and frequencies from our manual annotation can be observed in Table 1 .

Member and post selection for manual annotation.

Table 1

Frequencies and percentages of posts from the manual annotation.

r/trees N = 658 r/weed N = 2 r/Marijuana N = 875 r/stopsmoking N = 166 r/Cigarettes N = 37 r/Vaping N = 343 r/electronic_cigarette N = 67
Experiencer
First person experience 285 (43.3) 1 (0.5) 10 (1.1) 122 (73.4) 16 (43.2) 205 (59.7) 42 (62.6)
Experience other 20 (3.0) 0 (0.0) 0 (0.0) 12 (7.2) 0 (0.0) 7 (2.0) 1 (1.4)
General discussion 486 (73.8) 2 (100.0) 872 (99.6) 130 (78.3) 32 (86.4) 225 (65.5) 63 (94.0)
Temporality
Historical 14 (2.1) 0 (0.0) 1 (0.1) 46 (27.7) 1 (2.7) 3 (0.8) 4 (5.9)
Present 286 (43.4) 1 (0.5) 10 (1.1) 102 (61.4) 15 (40.5) 202 (58.8) 42 (62.6)
Future 6 (0.9) 0 (0.0) 1 (0.1) 2 (1.2) 0 (0.0) 17 (4.9) 1 (1.4)
Product
Marijuana 655 (99.5) 2 (100.0) 874 (99.8) 2 (1.2) 1 (2.7) 3 (0.8) 0 (0.0)
Combustible tobacco 33 (5.0) 1 (0.5) 6 (0.6) 165 (99.3) 37 (100.0) 14 (4.0) 8 (11.9)
ENDS 5 (0.7) 0 (0.0) 0 (0.0) 8 (4.8) 0 (0.0) 341 (99.4) 67 (100.0)

Annotations are not necessarily mutually exclusive.

Data Pre-processing

To pre-process our data for computational analyses, we first converted all of the Reddit posts to lower case. Using the Natural Language Toolkit (NLTK) (50), a widely used Python module for text analysis, we then split (i.e., tokenized) each post into individual word tokens. Lastly, we iterated through each token and removed any stop words. Stop words (e.g., “the,” “is,” “what”) are words that are common (51) but may not necessarily contribute semantic meaning to a corpus.

Latent Dirichlet Allocation and Word Clouds

While our manual annotation provides a comprehensive view of member experiences with cannabis, ENDS, and tobacco on Reddit, manually annotating our entire macro-corpus (N = 643,070) is not feasible. Consequently, topic modeling proves to be an invaluable method for studying commonly discussed topics within a large textual corpus. Latent Dirichlet Allocation (LDA) is one of these unsupervised machine learning techniques used to identify topics discussed in a corpus. Topics in an LDA model are represented by the grouping of words that are similar or co-occur throughout the corpus (51–53). LDA has been used to study several public health topics, including but not limited to infectious diseases, obesity, vaccinations, and health communications (32, 54–56), and has been shown effective in identifying salient topics within unstructured text sources such as social media. To develop our LDA models, we again used the Gensim library—as it supports various topic modeling techniques (45) and pyLDAvis to assist with the interpretation of the most salient terms for each topic (57). Then using our stratified macro-corpus (i.e., cannabis-specific subreddits, ENDS-specific subreddits, and tobacco-specific subreddits), we developed three distinct LDA models, one for each product type. We manually varied LDA model hyperparameters (i.e., number of iterations and batch size to train the models) to determine the optimal number of topics (k) to identify themes frequent to each product type. We then manually inspected the resulting terms with these varying k values to observe coherence between and ultimately determine the relevant number of k topics, as well as the best label that encompasses the observed terms. Lastly, using our annotated corpus, we developed a word cloud for each product type using the WordCloud Python library (58). These analyses together, allowed us to compare commonly discussed topics in both our annotated corpus and the larger macro-corpus.

Ethical Considerations

This study was determined to be exempt from review by the University of Utah Institutional Review Board (IRB#00076188). To protect Reddit member privacy, we have refrained from including usernames in this paper. Further, all quotations used are synthesized from multiple examples.

Results

Macro-Corpus

As seen in Figure 1 , we saw a large increase in member participation and the number of posts made in cannabis-specific subreddits in 2015, followed by decreases through 2018. In ENDS-specific subreddits, we observed annual increases in the number of posts within these subreddits between 2013 and 2016, followed by a slight decrease in volume in 2017 and a drastic decrease in 2018, whereas tobacco-specific subreddits saw continual increases in posts made and member participation per year between 2013 and 2018. In total, the 643,070 posts in our macro-corpus were posted by 257,048 unique members across all eight subreddits of interest. Some members deactivated their Reddit accounts between the date of the post and when we collected the Reddit posts. Therefore, those usernames are not available and are referred to as “[Deleted]” by the API.

As shown in Figure 2 , 63.7% of members (N = 163,816) posted exclusively in cannabis-specific subreddits, 18.8% of members (N = 48,623) posted exclusively in ENDS-specific subreddits, and 14.3% of members (N = 36,724) posted exclusively in tobacco-specific subreddits. The remaining ~3% of members posted in multiple product-specific subreddits. We observed 4,430 members posting in both cannabis and ENDS-specific subreddits, 2,052 members posting in both cannabis and tobacco-specific subreddits, 1,141 members posting in both ENDS and tobacco-specific subreddits, and 262 members who posted in cannabis, tobacco, and ENDS-specific subreddits.

Manual Annotation

The complete results of our manual annotation can be seen in Table 1. Of the 2,630 posts that we manually annotated, 2,148 (81.6%) posts contained at least one mention of either cannabis, ENDS, or tobacco products. 1,537 (71.5%) of these posts mentioned cannabis, 421 (19.5%) posts mentioned ENDS, and 264 (12.2%) posts mentioned tobacco. Only three posts explicitly mentioned the dual use of cannabis, ENDS, and tobacco products, and 11 posts explicitly mentioned transitions between these products. Two of the three posts mentioning dual use were made by one member. In these posts, the member explicitly mentioned their personal experiences with these products and stated current use of all three products. Upon closer examination of the posts containing transitions between products, six posts were made in the r/Vaping subreddit, three were made in the r/stopsmoking subreddit, and two posts were made in the r/electronic_cigarette subreddit. All 11 posts were related to past, ongoing, or planned smoking cessation attempts or associated relapse events, and none of these posts mentioned cannabis. Four posts discussed relapse from ENDS devices to combustible cigarettes, while three posts documented ongoing smoking cessation attempts using ENDS devices. Additionally, one post discussed a failed past cessation attempt using ENDS, two posts discussed contemplating the use of ENDS to facilitate a future cessation attempt, and one post discussed a relapse from ENDS devices to cigarettes and then subsequently reinitiating ENDS use.

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Within r/Marijuana, 16 members posted general discussions (e.g., news stories, questions, non-personal experiences with cannabis), and three members posted self-experiences with cannabis compared to r/trees where 70 members posted self-experiences with cannabis, and 65 members posted general discussions, suggesting that members are more likely to post personal experiences with cannabis in the r/trees subreddit compared to r/Marijuana. Of the 311 posts containing mentions of experiences with cannabis, 16 (0.5%) posts mentioned former use, 299 (96.1%) posts mentioned current use, and 7 (0.2%) posts mentioned potential use in the future. Of the 185 posts containing mentions of experiences with tobacco, 53 (28.6%) posts mentioned former use or past cessation attempts, 158 (85.4%) posts mentioned current use or current cessation attempts, and 7 (3.7%) posts mentioned potential use or contemplation of potential cessation attempts in the future. Of the 261 posts containing mentions of ENDS experiences, 13 (4.9%) posts mentioned former use, 252 (96.5%) posts mentioned current use, and 19 (7.2%) posts mentioned potential use in the future.

Latent Dirichlet Allocation and Word Cloud Analysis

In the LDA models applied to our macro-corpus, we observed six frequently discussed topics in cannabis-specific subreddits, four frequent topics in ENDS-specific subreddits, and two common topics in tobacco-specific subreddits. Cannabis-related topics included the legalization of medicinal and recreational cannabis, experiences with and recreational use of cannabis, the methods and forms of cannabis, health effects and uses of cannabis, and the cultivation of cannabis plants. ENDS-specific subreddits often held discussions of different flavors and nicotine solutions, accessories and parts, procurement of ENDS devices, and the use of ENDS for smoking cessation. And tobacco-specific subreddits often contained discussions of different brands and types of combustible tobacco and current, past, and planned smoking cessation attempts. Figure 4 provides the common terms used to derive each topic label from our LDA analysis and synthetic textual examples of these topics.

Resulting topics from our LDA analysis, accompanied by common terms observed in the topic and synthetic textual examples.

The observed topics from the LDA analysis of our macro-corpus closely mimic the terms from the word clouds of our annotated posts, as seen in Figure 5 . In the word clouds developed from our annotated corpus, the cannabis-specific word cloud consisted of terms including “cannabis,” “high,” “legalization,” and “medical.” In the tobacco-specific word cloud, we observed terms such as “smoke,” “quit,” and terms that may suggest temporality components of smoking cessation such as “time,” “today,” “month,” and “year.” Furthermore, in the ENDS-specific word cloud, we observed terms such as “flavor,” “tank,” “mod,” and “juice.”

Word cloud representations of our annotated corpus of 2,148 Reddit posts. Top left: all posts, top right: cannabis-related posts, bottom left: tobacco-related posts, bottom right: ENDS-related posts.

Discussion

Principal Findings

Reddit is a popular social media platform in which members post content in communities (subreddits) centered around everyday topics. Reddit posts are typically more verbose than other social media sites (e.g., Twitter, Instagram) and have numerous subreddits dedicated to the discussion of various aspects related to cannabis, tobacco, and ENDS products. Leveraging this structure, we studied eight subreddits focused on cannabis, tobacco, and ENDS, identifying emerging themes and analyzing how these themes differ between product types.

In cannabis-specific subreddits, we observed a large increase in the number of posts and the number of Reddit members within these subreddits in 2015. This observation is likely a result of the increase in proposed cannabis legislation in the mid 2010’s, a controversial topic of debate throughout the United States 7 . Our topic analysis of these subreddits also supports this finding as cannabis policy was one of the emerging themes discussed throughout our macro-corpus of posts. In addition to legislation and policy, members in cannabis-specific subreddits frequently talked of personal experiences with cannabis, the health effects of cannabis use, methods and forms of cannabis, and the cultivation of cannabis. Upon manual annotation and a closer examination of posts containing cannabis-related discussion, the subreddits r/weed and r/Marijuana appear to harbor more general discussion of cannabis, including discussion related to legalization and regulation, a finding also observed in prior work (32). The vast majority of posts containing personal experiences of cannabis were found in the subreddit r/trees. Within these experiential cannabis-related posts, members often talk about methods of consuming cannabis, experiences while under the influence, stories of cannabis use, and were typically centered around present use of cannabis. While previous studies have used other social media sites to explore the use of cannabis (59, 60), and a prior study compared cannabis use as discussed on one subreddit (35), no study, to the best of our knowledge, has studied aspects of cannabis use across multiple subreddits. Consequently, these findings are significant contributions—demonstrating the potential of Reddit data to explore opinions and use patterns of cannabis while also providing guidance as to which subreddits are best for studying personal use experiences versus general discussion. Based on our findings, future work that seeks to leverage Reddit for studying cannabis use and perceptions should do so using the r/trees subreddit.

From 2013 to 2018, we observed continual increases in the number of posts made and members participating in tobacco-specific subreddits. This sustained volume of posts within these subreddits may be a result of the observed increase in desire among smokers to quit in recent years (61), but may be an artifact of increasing usage of Reddit since 2012 8 . These patterns are consistent with our topic modeling analysis in which we observed smoking cessation frequently being discussed throughout posts made in tobacco-specific subreddits. In addition to aspects of cessation, we frequently observed discussions among current smokers regarding their favorite brands and types of combustible tobacco (e.g., Marlboro, unfiltered). These discussions were mostly housed in r/Cigarettes, a subreddit dedicated to discussions of cigarettes among smokers. Conversely, posts in r/stopsmoking were typically from current smokers attempting or contemplating a quit attempt, individuals experiencing relapse from a smoking cessation attempt, or individuals who successfully quit smoking and sustained their abstinence. In this subreddit, members documented their quit journey, including withdrawal symptoms and side effects, while also asking for advice to assist in their quit attempts. These findings reinforce the work of Chen et al., in which the investigators evaluated thematic elements expressed in the stopsmoking subreddit (62).

From 2013 to 2017, the frequency of Reddit members posting in ENDS-specific subreddits increased. These observed increases in ENDS-related posts may be a result of the increasing popularity of ENDS devices in the mid 2010’s but may also reflect the increase in Reddit traffic since 2012, as stated prior. Pew research surveys show that 22% of Reddit members are young adults between the ages of 18 and 29 9 , this in conjunction with the increase of members in ENDS-specific subreddits may reflect the findings of Dai and Leventhal that reported increases in current and daily ENDS use among young adult populations between 2014 and 2018 (63). However, we observed drastic decreases in both the number of members and number of posts within ENDS-specific subreddits in 2018. This observation contradicts survey findings that the prevalence of ENDS use among US adults in 2018 had reached a watermark high of 7.6% over the previous 5 years (63). Most posts made in these subreddits focused on nicotine flavors, accessories, procurement of ENDS devices, as well as smoking cessation using these devices. Reddit members in the r/Vaping and r/electronic_cigarette subreddits often posted about their use patterns and experiences with ENDS devices. Consequently, member-specific participation in ENDS-related subreddits, as well as their participation in separate health-related subreddits over time (e.g., r/Health), may provide insight and generate hypotheses into the potential health effects attributable to prolonged ENDS use, and serves as a potential avenue for future computational epidemiology research.

As the scope of our manual annotation (i.e., characterizing product mentions of cannabis, tobacco, and ENDS) and our topic modeling differed, we developed word clouds in an attempt to broadly compare the similarity of discourse between posts contained in our annotated corpus and the larger macro-corpus. We found that the frequently observed terms in our annotated corpus closely resembled those topics discovered in our topic modeling, and therefore we hypothesize that many of the characteristics seen in our annotated corpus (e.g., members frequently discussing present cannabis use patterns, discussion of present smoking cessation attempts) may be frequently discussed throughout the entire macro-corpus, providing a potential avenue for future work.

In our manual annotation, we only observed three explicitly mentioned instances of product dual use. This is likely an artifact of our sampling strategy as we only annotated posts from 124 specific members where dual use was evidently uncommon. We anticipated more instances of product dual use than we observed in our manual annotation, as a substantial body of epidemiologic studies have demonstrated frequent use of multiple product types (1–4), and through the observation that many members posted in multiple subreddits as seen in Figure 2 . Though we were not able to ascertain frequent dual use within this study, Reddit members may disclose these habits within individual posts, outside of the relatively small sample size of annotated posts reported in this study. Few posts explicitly discussed transitions between cannabis, ENDS, and tobacco. And of the posts that did mention transitions, all of said posts discussed transitions between ENDS and combustible tobacco use, with no posts mentioning transitions to or from cannabis. These posts frequently discussed current smoking cessation attempts facilitated by ENDS, in addition to relapse events from ENDS devices to combustible tobacco. These findings showed that Reddit members in our annotated corpus seldom talked about transitions between these products, and when they did, they were often centered around usage in smoking cessation attempts. However, these patterns of transition may be more common in the larger macro-corpus upon further analysis.

Our study has some limitations to be considered. First, our analysis was limited to posts from eight popular subreddits focused on cannabis, ENDS, and tobacco. However, the content posted in these subreddits may contain posts discussing non-related topics (i.e., topics not related to cannabis, ENDS, tobacco). Although our work focused on larger subreddits, additional subreddits also discuss cannabis, ENDS, and tobacco products, such as r/leaves (i.e., discussion of cessation from THC-containing products). Future work may look to build on our analysis and include these additional subreddits closely related to cannabis, ENDS, and tobacco products (e.g., r/cannabis, r/vaporents, r/DIY_eJuice, r/cigars, r/hookah). Second, while we manually annotated 2,630 Reddit posts, these posts only encompassed 124 Reddit members as a result of our sampling strategy. Although we observed use patterns comparable to prior epidemiologic studies, we cannot ascertain the geographic locations of Reddit members, nor can we assume that posts, opinions, and use patterns observed in our analysis are representative of all cannabis, ENDS, and tobacco members. Therefore, we cannot generalize these findings to the general population. Furthermore, this small sample of members may not encompass the true representation of our attributes of interest as seen on Reddit. Third, social media sites often fall victim to a phenomenon known as the 90-9-1 principle (64), where the large majority of members on a social media site just observe posts and do not contribute, a small proportion of members contribute sparingly, and a small number of members who contribute the majority of posts. Consequently, any findings resulting from social media data are difficult to generalize to the general population. Fourth, as seen in Figure 1 , there was an observed decrease in posts collected during 2018. We expected to see continual increases in posts made in 2018, as a result, these observed decreases may be a result of decreases in the number of posts retrievable by the API, or discrepancies with parsing posts collected by the API. Finally, the posts in our analysis were collected between 2013 and 2018. With the consistently changing landscape regarding ENDS devices, cannabis legislation, and combustible tobacco use, our results may differ upon the analysis of more recent posts from these subreddits.

Conclusion

In conclusion, our study compared aspects of cannabis, ENDS, and tobacco use across multiple subreddits on the social media site Reddit. We found that Reddit posts provide firsthand accounts of cannabis, ENDS, and tobacco use and can complement findings derived from traditional survey-based approaches. In subreddits dedicated to cannabis, members frequently discussed personal experiences, methods and forms of use, legislation and policy, the associated health effects of its use, as well as the cultivation of cannabis plants. In tobacco specific subreddits, members often talked about ENDS devices, documented their smoking cessation attempts, and discussed brands and types of cigarettes. Further, ENDS-specific subreddits were often focused on parts and accessories, flavors and nicotine solutions, the procurement of ENDS devices, and discussion of smoking cessation using ENDS devices. Upon closer examination of these posts, the r/trees, r/stopsmoking, r/Vaping, and r/electronic_cigarette subreddits were more commonly used to discuss personal experiences with cannabis, ENDS, and tobacco. Future computational research should look to expand upon the manual annotation scheme presented and develop models to classify personal experiences from general product mentions for a more focused analysis on cannabis, ENDS, and tobacco use as presented on Reddit.

Data Availability Statement

The datasets presented in this article are not readily available because this dataset contains social media usernames which if shared, may result in the identification of those individuals. Consequently, this data is not to be shared. Requests to access the datasets should be directed to [email protected]

Author Contributions

RB and MC conceived the study idea with support from S-HZ. MC, MH, AC, and RB developed the annotation scheme presented and carried out the manual annotation of the data. RB developed the computational models and analyzed the data. RB also led the manuscript writing with support from MC, AC, and S-HZ. All authors contributed to the article and approved the submitted version.

Funding

The research reported in this publication was partially supported by the National Institute on Drug Abuse of the National Institutes of Health under award number R21DA043775. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the National Institute on Drug Abuse. This study was also partially supported by grant number T15LM007124 from the National Library of Medicine. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Library of Medicine or the National Institutes of Health.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Acknowledgments

We would like to sincerely thank Sheetal Hardikar PhD, Greg Stoddard MPH, and Tengda Lin MPH at the University of Utah for their guidance and insight into the statistical analyses of our findings.

Want to Quit Smoking? Study Says CBD Oil Can Help

Firstly, let’s clear the air – we are not suggesting that you should start smoking weed in order to quit smoking cigarettes.

Unlike THC, the primary compound found in most commercially grown cannabis plants, CBD doesn’t get you “high.” It is a secondary cannabinoid extracted from CBD-rich cannabis plants or hemp (cannabis plants with less than 0.3% THC content), and it is responsible for all the positive health benefits of consuming marijuana and none of its mind-altering effects and body load. CBD oil has numerous health applications which are being more and more understood by science. One of these applications is to disrupt addictions to substances such as nicotine.

The Scope of the Issue

Cigarette smoking is a massive public health problem. In the US, although cigarette use has greatly declined since the days it was allowed on flights and in hospitals, there is still a concerning number of people addicted to tobacco. According to a 2017 CDC survey, almost every fifth American adult uses some tobacco product; over 41 million of those individuals are cigarette smokers.

The data becomes even more troubling if we look at the 2019 FDA & CDC National Youth Tobacco Survey, which shows that over 5 million American youth are active users of e-cigarettes. Although vaporizing is supposedly less harmful than using combustible tobacco products (this is debatable and with insufficient evidence; we will discuss it later), it does have its own risks. The critical issue is that many of these teenagers will develop long-lasting nicotine addiction, and some of them are likely to also start smoking regular cigarettes.

E-cigarette use is rapidly rising, and nicotine is reaching record numbers of the population within the younger demographic. This process is undermining the overall national-level efforts of reducing tobacco use, and we can expect to see an uptick in smoking statistics during the coming years if everything continues as it is.

The Health Risks of Smoking

It goes without saying that smoking is bad for health. However, it doesn’t hurt to briefly review some of its main dangers. Smoking makes you several times more likely to contract many kinds of cancer, and especially likely to develop oral, esophageal, or lung cancer. It does irreversible damage to your lungs, which can increase the risk of contracting dangerous conditions such as pneumonia or chronic bronchitis. Smoking also damages your cardiovascular system, making you more prone to heart disease or stroke. It has also been correlated with erectile dysfunction and sub-fertility.

Biochemical damages of smoking aside, inhaling smoke which is the result of combustion of solid matter is genuinely bad for the body because our lungs are not made to withstand such heat. When a cigarette or joint is burned, the temperature at which the smoke is inhaled creates an environment of stress for all the organs it passes through – the mouth, the esophagus, and the lungs. In time, these organs can suffer irreversible cumulative damage, which is why smoking is associated with higher risks of developing chronic health issues.

The Current Options

Main conventional treatments for smoking cessation currently include:

  • nicotine replacement therapy (NRT), which relies on delivering small doses of nicotine into the bloodstream. It can come in several forms, including skin patches, chewing gum, inhalators (which look like plastic cigarettes), tablets, oral strips and lozenges, or nasal/mouth sprays.
  • medication such as Varenicline (Champix) or the antidepressant Bupropion (Zyban).
  • e-cigarettes, which are commonly viewed as the lesser evil, and may be used to gradually wean one off nicotine by using lower cartridges with lower concentrations.

Using CBD Oil to Stop Smoking

An emerging natural treatment option with almost negligible side effects is CBD oil. Numerous studies have already demonstrated the ability of CBD to interrupt addictive behavior in general. One highly important study, however, focused specifically on smoking, and reported that a week of CBD treatment reduces the number of cigarettes smoked by about 40%.

In this study, 24 smokers were recruited and split into two groups; one group received inhalers containing CBD oil and the other one received inhalers containing a placebo. Both groups were told to use the inhalers whenever they felt the urge to smoke for a period of 7 days.

The study found that while the placebo group showed no difference in their smoking habits, the group which was using CBD oil reduced the number of cigarettes consumed by 40% on average.

Dr. Morgan, one of the researchers in this study, concluded that “CBD might mean the positive smoking memories are gradually erased,” meaning that a new association is formed between the craving, the physical motions involved with having a cigarette (replaced with the inhaler), and the healing effects of the CBD (which replaces the satisfying effects of the nicotine).

Merely replacing the process of smoking with inhaling a dose of CBD oil seems to calm the craving for nicotine and make cigarettes seem at least acutely unattractive. This represents a great psychological benefit for those who are seeking to use CBD oil to quit smoking as the physiological pattern is quite strong in smokers, and especially connected with the state of mind during stressful or social situations.

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However, Dr. Morgan says it is hard to draw a direct comparison with other therapies based just on the results of her team’s study. She stated that “This (40%) was more than expected. However, it is difficult to compare to other smoking cessation therapies as we did not ask people to stop smoking, simply to try using the inhaler when they wanted a cigarette.”

Although various treatments for cigarette addiction are available, researchers are always searching for more effective and natural alternatives. CBD oil seems to be a promising candidate on account of Dr. Morgan’s research and some other more recent studies, such as this one, which found that even a single overnight dose of CBD can reduce the salience and pleasantness of cigarette cues (pictures of tobacco products) in smokers the following morning.

How Does CBD Help in Quitting Smoking?

CBD is known to act as a stimulant of the parasympathetic nervous system (responsible for promoting rest, healing, rejuvenating, and regenerating) and as an inhibitor of the sympathetic nervous system (responsible for eliciting responses to stress and triggering the fight-or-flight mechanism). Its calming effects are harnessed to relieve anxiety, depression, pain, and stress in general. All of these factors correlate with smoking, and alleviating them can greatly contribute to how efficiently smokers can use CBD oil to stop smoking.

All this said, the science of the therapeutic effects of CBD is still in its infancy and we don’t quite understand its addiction-breaking action on a neurochemical level; however, numerous positive anecdotal reports are abundantly available online. People seem to be having genuine success with using CBD oil to quit smoking both cigarettes and THC-rich cannabis.

It is important to note that CBD has not been approved by the FDA as a treatment for any condition other than epilepsy. For this reason, dosages and way of intake are not standardized, and need to be determined subjectively.

Ways to Take CBD to Quit Smoking

For many cigarette smokers, switching to CBD joints presents a very natural transition. Aside from the nicotine dependence, a large part of the addition to smoking is the actual process of burning a cigarette and inhaling its warm smoke. It’s almost like a ritual to many.

Although there is no scientific research available on this specific method of smoking cessation, numerous anecdotal reports suggest that smoking CBD joints can lead to diminishing the number of cigarettes smoked, or kicking the habit altogether. You can see some personal accounts if you scroll down to the comment section of this article!

The most common way of CBD intake, however, is by vaporizing CBD oil using a special device called a vaporizer or “vape.” When you consume CBD oil with a vaporizer, it’s not actually burned but heated to just the right temperature for it to start converting into aerosols. This temperature is, naturally, much lower than the temperature needed to convert solid plant material into smoke. Many smokers decide to transition to vaping CBD oil to quit smoking because of these apparently lower health risks and because it’s more convenient to buy and use CBD oil than it is to buy and smoke CBD joints.

Psychologically, vaping as a method that resembles smoking can also potentially help tobacco users drop the habit. A 2014 global survey of over 19,000 cigarette smokers found that 81% of respondents had completely transitioned to e-cigarettes, while the rest cut down on the number of cigarettes smoked while simultaneously vaping. These results imply that vaporizers can act as a psychological substitute for cigarettes; the combination of transitioning to a vaporizer and using the addiction-breaking properties of CBD oil to stop the nicotine cravings should, in theory, eventually lead the user to quit smoking altogether.

It’s necessary to point out, however, that even inhaling the vapor cannot be considered completely safe because it still puts a burden on the lungs. Vaping is a recent invention, so there are few studies showing how harmful it is. The first study of its kind, which looked into the health effects of long-term e-cigarette use, however, found that people who vape are still about 30% more likely to develop chronic lung problems such as asthma or emphysema.

On the one hand, this number is drastically lower compared to the statistics for cigarette smokers reported in the same study, which indicate that they are 250% more likely to develop chronic lung diseases than non-smokers. On the other hand, the data for the study was collected over a period of only three years, so it’s likely to be an underestimation. Still, compared to burning solid plant matter, it’s physically and logically reasonable to assume that lower temperatures will result in much less tissue damage, even in long-term use.

If you’re categorically opposed to vaporizing and/or feel like you should kick the habit of inhaling altogether, there are other ways to ingest CBD. You can take it in capsule form, as a chocolate, or in gummy bear form. The thing is, though, that consuming CBD orally makes it travel through the digestive tract, ultimately arriving to the liver, where it’s metabolized. This means that it takes longer for its effects to start (about 30min to 2h), which is not ideal for quitting smoking – the nicotine cravings don’t really have patience.

An in-between solution is applying CBD tinctures sublingually. Sublingual administration allows the CBD to be relatively rapidly absorbed (in about 5 to 20min).

In conclusion, although CBD has to undergo more scientific verification as a tool for smoking cessation, the results so far, coupled with the myriad anecdotal reports, are quite encouraging. Finally, aside from using CBD oil for quitting smoking, you also stand to benefit from its numerous other medicinal properties. All in all, considering the dangers of smoking and the very low risks involved with using CBD oil, it is definitely worth a try.

Have you tried using CBD oil to stop smoking already? What are your experiences?

If you haven’t, are you considering it? What are your concerns?

Please share them with us in the comments below.

About Xavier Francuski

Born in India, grew up in Serbia, lived and traveled throughout the world, Xavier’s uprooted existence fuels his instinct for exploration. With a masters degree in research psychology, he is a passionate educator on the topic of psychedelics, trying to reconcile the astounding nature of the realms beyond with what sense we can make of them in this one. Currently living in Southeast Asia and working as a staff writer for several major psychedelic websites.

9 Comments

I just quit smoking this past Monday. In the past I had used Chantix, a very powerful drug for stopping tobacco use. Due to my insurance no longer covering Chantix I tried CBD in the flower form. (17%)

I am amazed to say i have had just as easy of a time quiting as I had from the use of Chantix. (But with no apparent side effects using CBD)

The problem with quiting tobacco is not quiting. It is staying a non smoker. (Quiting is just the first step as all smokers know who struggle with quiting)

Once I have quit smoking CBD allows me a substitute for the occasional but powerful urges to pick a cigarette back up. These continue long after quiting smoking.

Can Cbd oil help with the disease als? I was diagnosed in January. Please help me. I am interested in the knowledge that you have.

I have read many conflicting reports about CBD oil, some stating that the effective ingredient that is currently legal to sell is way too low to be effective for any health benefits.

I have smoked for nearly 20 years, tried everything else but none has worked. I am now thinking desperately, as my daughter suggested to try cbd drops. Help me but which one. I am 67, and Want to stop smoking for my health. Its time now.

I have lung cancer I have every thing out there I need to stop .this is the only thing I have not try because i have a CDL this is one thing you do not do with that but my life depend on stop smoking.

I have COPD & really need to quit smoking – can’t wear the patches – they burn my shoulder – is this a one time try to see if it works for you & won’t keep hitting my account?
Thank you & please advise what I should try.

I have struggled over the years to quit many different substances the last two was marijuana and cigarettes. Someone suggested I use CBD oil to help me with the marijuana withdrawals I purchased CBD oil that was about 2 weeks Supply I stopped smoking the marijuana and use the CBD as directed on the package and within 10 or 11 days I was completely off the CBD and the marijuana I have not touched marijuana in a few months now and I’m feeling confident that I want to try to use CBD oil to help me with stopping cigarettes. My biggest complaint about trying to quit a substance is my attitude bitchiness and uneasiness that I feel. I remained very mellow and calm was not angry when I use CBD to quit marijuana. So again I’m going to try CBD to quit smoking cigarettes I’m feeling really confident that it’s going to be helpful.

Hi Karen, were you successful in finding a sample?
[please don’t put your email in comments -administrator]
Thanks, Pam

I’m 67 and I have 2nd stage COPD as well so I’ve been vaping CBD in place of my cigarettes. Unfortunately I smoked almost 2 packs a day. Therefore, I’m vaping a whole lot. This is helping me not to smoke but. I’ve begun to get stomach ill nauseous for sure. I think I need to cut down on the strength of the CBD. So, I’ve ordered some lower strength CBD for my cartridge. I will let you know how it goes. I can say that vaping CBD definitely helps. The actual (smoking action) helps my addiction, putting the pen to my mouth, the inhaling and exhaling clouds of smoke, somehow makes me feel like I haven’t gave up smoking at all. The CBD itself relaxes me enough to not be agitated or frustrated from not smoking nicotine. I’ll right back again when I get my new lower strength CBD in. Thanks for listening, Brenda

e-Cigarette Cessation: Content Analysis of a Quit Vaping Community on Reddit

Laura Struik, School of Nursing, Department of Health and Social Development, University of British Columbia Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, Phone: 1 2508079972, Email: [email protected] .

Laura Struik

1 School of Nursing, Department of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada

Youjin Yang

1 School of Nursing, Department of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada

Copyright ©Laura Struik, Youjin Yang. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 25.10.2021.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

Abstract

Background

e-Cigarette use, also known as vaping, has increased dramatically over the past few years, especially among younger demographics. However, researchers have found that a large number of e-cigarette users want to quit. Little is known about the unique aspects of vaping cessation, which is critical to informing the development of relevant resources and interventions for e-cigarette users who want to quit. Social media forums such as Reddit provide opportunities to understand the experiences of behavior change such as quitting vaping from the perspective of end users.

Objective

This study aims to examine a quit vaping subreddit to understand how e-cigarette users are experiencing and approaching vaping cessation. Specifically, we examine methods used to approach quitting, reasons for quitting, and barriers and facilitators to quitting.

Methods

A total of 1228 posts were collected. The posts were inductively coded to generate categories and subcategories using conventional content analysis. Data were analyzed using the NVivo 12 qualitative data analysis software.

Results

Most users reported a preference for approaching quitting through gradual reduction, particularly through the use of their own devices by tapering the nicotine content. Their reasons for quitting were primarily related to experiencing negative physical consequences associated with vaping, especially in relation to their lungs (eg, tight chest), and tired of feeling stuck to the vape because of nicotine addiction. Top barriers to quitting were related to withdrawal symptoms and intensity of addiction. The top facilitators to quitting were related to using distraction techniques (eg, hobby, gaming, and mindfulness exercises), as well as having a positive mindset.

Conclusions

The findings of this study reveal unique aspects that encompass the process of quitting vaping. These findings have significant implications for both policy and intervention development.

Keywords: qualitative research, electronic nicotine delivery systems, vaping, cessation, social media

Introduction

Vaping with nicotine, or using e-cigarettes, has become a popular global phenomenon in recent years. Compared with 2011, whereby 7 million people worldwide used e-cigarettes, the number of e-cigarette users had increased to 41 million in 2018 [1], with youth and young adults representing the largest users of e-cigarettes [2]. Despite how vaping has grown in popularity, recent evidence indicates that a large number of e-cigarette users actually want to quit [3-6]. A focus group study in Canada found that >40% of youth and young adults who vaped indicated a strong desire to quit, and >40% had tried to quit in the past year [5]. Another study in the United States found that 45% of youth were interested in quitting, and 25% had tried to quit in the past year [4].

Although it is encouraging that many e-cigarette users want to quit, there remains a lack of cessation services to support their quit efforts. Researchers acknowledge that most cessation advice mimics smoking cessation [7] and that there is a dearth of resources tailored specifically to vaping [4,5]. The 2020 Surgeon General’s report on smoking cessation called for research to develop and understand safe and effective e-cigarette cessation guidelines and interventions [8]. A critical step toward developing effective cessation resources is to first understand the experiences and preferences of e-cigarette users as it relates to quitting vaping. However, no studies to date have examined how vapers quit and what might help them with quitting.

Web-based forums serve as particularly fruitful platforms for gathering information on end user experiences and preferences. Reddit, the most comprehensive forum on the internet [9], has several e-cigarette–related discussion topics. The use of social media such as Reddit to understand vaping cessation experiences is particularly important given that engagement on social media platforms for sharing and gathering health information is highest among youth and young adults [10,11]. Researchers have studied Reddit discussions to generate important information about e-cigarette flavors [12], the health effects of e-cigarette use [13,14], e-cigarette use patterns [9,15,16], reasons and attitudes surrounding underage e-cigarette use [17], and underage buying and selling [18]. However, no researchers have examined the quit vaping communities that are now on Reddit. This user-generated content around vaping holds significant potential to inform best practices for cessation guidelines and services. Therefore, we examined a quit vaping subreddit to understand how e-cigarette users experience and approach vaping cessation. Specifically, we examined methods for approaching quitting, reasons for quitting, and barriers and facilitators to quitting.

Methods

Overview

Similar to other studies involving Reddit [17-19], the examined subreddit contains publicly available threads and comments. No personal information (eg, account details) was included, and the usernames of the Reddit posters were not presented in this study. As such, this study was classified by the University of British Columbia Okanagan’s Behavioural Research Ethics Board as research not involving human subjects and was, therefore, not subject to institutional review board jurisdiction.

Data Collection

We examined the subreddit r/QuitVaping community for this study. This subreddit was created in 2015 and designed to help vapers motivate each other to quit. This subreddit contained 4700 subscribers. Posts (including original posts and all responses) were collected retrospectively during a 4-week period (August 1, 2020, to August 31, 2020) by using the top posts of this month feature. The top posts of this month means that the posts with the most upvotes over this period were selected for analysis. This approach to data collection is supported by other content analyses of subreddit communities (eg, see work by Sowles et al [19]). The posts were first copied and pasted onto Microsoft Word, which were then uploaded onto the NVivo 12 qualitative analytic software (QSR International Pty Ltd) for coding. A total of 1228 posts were collected and analyzed.

Data Analysis

The posts were inductively coded to generate categories and subcategories using conventional content analysis [20]. Both authors engaged in collaborative coding via UBC Zoom to code three original posts and 10 responses (13 total), which resulted in the assignment of 44 codes. The authors developed a coding legend and assigned preliminary codes directly onto the Microsoft Word document via the comments feature. The authors then independently reviewed an additional set of three original posts and eight responses (11 total). Each author assigned >35 codes. Only six discrepancies in coding were noted, which were then discussed, resolved, and worked into the coding framework. The second author then independently coded the remaining posts, consulting with the first author regularly as needed. Once all the posts were coded, authors met again and refined and collapsed the framework with subcategories under the four major categories of quitting methods, reasons for quitting, barriers to quitting, and facilitators to quitting.

Results

Users

In total, 318 unique users were represented in this sample of posts. A little less than 10% (29/318, 9.1%) of the represented sample indicated their age, with most (24/29, 83%) of them in the young adult age range (aged between 18 and 35 years), and the remaining outliers were aged 35 years (3/29, 10%). This may indicate a relatively young sample overall.

Posts

Of the 1228 posts, 189 (15.39%) were original posts, and 1039 (84.61%) were responses to these posts. The average number of responses per original post was 5.5 (SD 5.55), and the range in the number of comments per post was 0-50, with most posts within the range of 5-10 and only one post with 50 comments. This one post is noteworthy, as the engagement was garnered through a call to action for mutual support and accountability. The post is as follows:

Everyone who is actively quitting/trying to quit/already did quit and wants to keep it that way, comment on this post. I will send each of you a message on reddit every single day checking up on you, and sending you motivational things to aid in your journey. Only asking that you try and do the same for me 🙂 let me know.

The data within these 1228 posts are broken down into the following four categories: quitting methods, reasons for quitting, barriers to quitting, and facilitators to quitting ( Table 1 ). The most represented categories of post content in this data set were related to barriers and facilitators to quitting.

Table 1

Representation of post categories (N=1228).

Category Values, n (%)
Quitting methods 175 (14.25)
Reasons for quitting 211 (17.18)
Barriers to quitting 441 (35.91)
Facilitators to quitting 570 (46.42)
Quitting Methods

e-Cigarette users’ method of quitting was reflected in 14.25% (175/1228) of posts. Most of these posts (117/175, 66.9%) reflected a preference for a gradual reduction approach. This was accomplished primarily by tapering the nicotine concentration (55/175, 31.4%), which was followed by the use of different sources of nicotine replacement therapy (NRT; 33/175, 18.9%; eg, patches, gum, lozenges, toothpicks, and Nicorette inhalers). The most popular NRT used were patches and gum, which are often used together. Overall, 13 users reported using nicotine pouches to help them quit, and 6 stated using the vape less frequently. The cold turkey approach was represented in 33.1% (58/175) of the posts.

Reasons for Quitting

The reasons for quitting vaping were provided in 17.18% (211/1228) of posts ( Table 2 ). There were eight reasons for quitting, as listed by the posters. The number one reason for quitting vaping was experiencing negative physical health effects of vaping, which included shortness of breath, chest pain, wheezing, coughing, sore throat, poor oral health, poor skin health, and poor sleep quality. The second most commonly cited reason to quit was that individuals were tired of feeling stuck to their e-cigarettes, indicating that they wanted to be free to live their lives without a dependency on a vaping device. The other most common reasons for quitting are related to the mental health and financial cost of vaping. These top reasons were then followed by a desire to improve physical health (eg, to improve running time), accommodate life changes (eg, having a baby), to gain time they would be otherwise using to vape or think about vaping, and to improve their intimate relationships (eg, spending time with partners who do not vape or smoke).

Table 2

Reasons for quitting (N=211).

Reason Values, n (%) Representative quotes
Experiencing negative physical health consequences 59 (28.0) “I vaped for 3 years too, very consistently, and I really didn’t have a problem with it until I felt the health issues—constant dry throat, never ending phlegm, tonsil stones, fatigue, swollen lips (from vape juice spitting), irritability, and horrible acne. I also felt like I hadn’t been myself for awhile.”
Tired of feeling stuck to the vape or nicotine 47 (22.3) “Last night, I had a moment of clarity. My whole life basically revolves around my vape. It’s my first thought when I wake up every morning, I have to constantly have it with me, and everything ends with a vape. Anytime I’m without it, I’m just looking forward to the time I can use it. It’s honestly hard to imagine life without it, but I know I don’t want to be a 70-year-old vaper.”
Experiencing negative mental health consequences 28 (13.3) “I’m fed up with feeling that anxiety and irritability when I’m not vaping.”
Financial loss 28 (13.3) “I had to get to a point where I hated what it was doing to me and my finances.”
Wanting to improve physical health 17 (8.1) “I was hoping quitting would help me with my run times before being winded (which currently doesn’t take too long).”
Need to adapt to life changes 17 (8.1) “But with Covid and everything happening, I want to kick this addiction to the curb.”
Improve use of time 6 (2.8) “Vaping sucks so much it makes you procrastinate, it makes you feel lazy and it makes you run away from things that need to get done.”
Prioritizing intimate relationships 6 (2.8) “Now I’m married and have a 1 year old child and my wife hates me vaping especially since she found out how poisonous the vape juice is for children and she’s always concerned about me accidently leaving my vape around our child.”
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Barriers to Quitting

Barriers to quitting were reflected in 35.91% (441/1228) of the posts. Nine barriers were found, which were listed in the order of most saturated to least saturated ( Table 3 ). The most challenging barrier was related to nicotine withdrawal, with reports of intense withdrawal symptoms associated with trying to quit. The second most common barrier was related to nicotine dependence, with many users citing heavy addiction because of the nicotine salt devices that many of the posters were using (eg, JUUL). The third barrier was related to proximity to others who vape as a major barrier to quitting, which included both web-based (eg, seeing friends vaping on social media) and offline interactions. The fourth barrier to quitting was related to existing mental health challenges, whereby users described how their stress, anxiety, or depression made it harder for them to quit. The fifth barrier was related to the use of other substances, including smoking traditional cigarettes and other drugs. The sixth barrier was related to vaping becoming habitual and associated with routine things such as commuting to school or work. The seventh cited barrier was related to the accessibility of vaping from both a purchase standpoint as well as from a use standpoint, as users could vape in areas where smoking is prohibited. Other barriers to quitting included the enjoyment of vaping and experiencing weight-related issues after stopping.

Table 3

Barriers to quitting (N=441).

Barrier Values, n (%) Representative quote
Intense withdrawal symptoms
Insomnia; fatigue; sweats; headache; brain fog; chest pain; cough; sore throat; dizziness; anxiety; depression; irritability 137 (31.1) “I’m 2 days in from daily use but my pulse is around 90-100 bpm when I’m just sitting is this normal? People already told me being anxious 24/7 is common but I feel like my heart won’t stop beating fast all day and night. I feel like I can’t sleep because I’m so anxious about nothing and my heart won’t stop beating quick.”
Dependency on high nicotine
JUUL; using >20mg/ml 116 (26.3) “I’m telling you, the nic salts will get you every time. Juuls are just icing on the cake.”
Proximity to those who vape
Face-to-face interactions; web-based interactions 41 (9.3) “I used to see vapes on peoples social media and I would get insane cravings out of nowhere.”
Mental health challenges
High stress; suffer from anxiety or depression 39 (8.8) “Convinced myself it would help with the stress and anxiety of everything going on.”
Other substance use
Smoking cigarettes; other drugs 34 (7.7) “Add in that I took Adderall daily, which if anyone doesn’t know, makes your desire to smoke increase x10000000. So breaking into pod #3 in a day wasn’t unheard of.”
Habit or routine associations
Commute; other day-to-day habits 25 (5.7) “I’m a delivery driver and I think I connect vaping with driving also. But of course now, I vape all the time. In bed, at least 20 minutes after waking up, want it after a meal and an absolute must have when I’m drinking alcohol.”
Accessibility of e-cigarettes
Easy to purchase; can use anywhere 19 (4.3) “Vaping I did 10x more than smoking! So easy to do anywhere.”
Other
Enjoyment of vaping 13 (2.9) “Also a non-drinker and I feel it’s my only guilty pleasure [. ] I haven’t tried to stop yet.”
Increased appetite or weight gain after stopping 13 (2.9) “When does the binge eating stop? I’ve been 2 weeks nicotine free and still wanna eat constantly and gained so much weight.”
Facilitators to Quitting

Approximately 46.42% (570/1228) of posts provided a description of facilitators to quit vaping ( Table 4 ). Nine facilitators to quitting were identified. The most cited facilitator to quitting was distractions, with the number one distraction strategy relating to keeping their minds and hands busy through hobbies, movies, games, and mindfulness exercises. Another common distraction strategy was by replacing puffing on an e-cigarette with eating, chewing gum, drinking water or tea, or chewing on flavored toothpicks. Finally, users spoke about the key role that exercise plays in their quitting efforts from running to weight lifting to yoga.

Table 4

Facilitators to quitting (N=570).

Facilitator Values, n (%) Representative quote
Distractions
Keeping mind or hands busy (hobby, entertainment like movies and gaming, and mindfulness exercises); eating, chewing gum, drinking water or tea, and toothpicks; exercise 279 (48.9) “I am trying to just live in the moment instead of having to pacify every single discomfort with nicotine. A workout program I follow always says ‘get used to the discomfort’ and that thought has been on repeat in my mind. Deep breaths and meditation have been helping a lot too.”
Positive mindset or positive self-concept
Resilient mindset; progress mindset (winning streak); self-care, grace, or rewarding 63 (11.1) “This time feels a lot different though. I am being nice to myself. Letting myself be irritated, eat as many snacks as I want, and really feel my feelings.”
Social support
Support from others (Reddit community, friends, and family); quitting with someone 54 (9.5) “This little community has made a huge difference on my mindset on quitting!! We all want the best for each other.”
Making vaping less accessible or less desirable
Tossing device; having someone hide device; using undesirable flavors 54 (9.5) “When I used zero [nicotine], I just kept my device somewhere completely across the house so it was never instantly accessible. It’s much easier to say no when you think about how little you actually get for the effort of going to grab it.”
Behavioral support
App (Quit Vaping); Allen Carr Quit smoking the easy way; quit help websites 34 (6.0) “And use some app like quit vaping [app name]. Being able to easily see milestones and achievements is very motivating at the start.”
Other
Awareness of negative effects of vaping 23 (4.0) “I always thought it helped with my anxiety but it honestly only ever made it worse.”
Reminders of reasons to quit 17 (3.0) “I was actually in one of those zones thinking, ‘It wasn’t so bad, maybe I just “like” vaping’ when I started writing this post. By the end of writing it, I remembered how bad my experience really was and haven’t had a craving since.”
Experiencing benefits of not vaping 11 (1.9) “I quit two months ago and have only recently started to really feel the positive benefits, but from what I’ve experienced, it’s totally worth it.”
Changing environment (social or routine) 11 (1.9) “I am moving into a house with some very supportive people and I’ve found that when in a new setting, cravings are a lot lower.”

The second most cited facilitator to quitting was related to having a positive mindset or a positive view of self. Individuals described the need to believe in themselves, encourage themselves, care for their mind and body, grace with themselves, and reward themselves. In addition to self-love was the value of social support for quitting vaping. Although the primary source of support drawn upon was others in the Reddit community, some described the positive support received from family, friends, and even quit buddies to help them quit.

Making vaping less available or desirable was another facilitator to quitting vaping, which was achieved through a variety of strategies, including tossing the device, having someone hide the device, and purposely using undesirable flavors to dissuade them from vaping. Another facilitator to quitting was through the use of behavioral support interventions, which was primarily sought through the Quit Vaping app, followed by Alan Carr’s book “Quit smoking the easy way,” and then websites that provide information on vaping cessation.

Experiencing the negative effects of vaping, being reminded of their reasons to quit vaping, experiencing the benefits of quitting, and changing their environment (eg, staying away from people who vape, switching up routine, and taking a vacation) were also listed as facilitators to remain vape free.

Discussion

Principal Findings

This study is the first of its kind to examine a quit vaping community on Reddit to understand the process of quitting vaping from the perspective of e-cigarette users. The findings of this study shed light on what quitting vaping is like and how it aligns with quitting smoking. The findings reveal that the process of quitting vaping with nicotine, although similar to quitting combustible cigarette smoking in many respects, is also unique in several noteworthy ways.

Quitting Methods

Both cold turkey and gradual reduction are relevant to vaping cessation. However, significantly more e-cigarette users opted for gradual reduction compared with cold turkey. This is unique compared with smoking, whereby most smokers opt for the cold turkey approach [21]. Interestingly, a large portion of those who chose gradual reduction chose to do so by tapering their vaping device. The fact that e-cigarette users are trying to figure out how to quit on their own in this way reflects the dearth of evidence-based support available to those who want to quit and is indicative of the urgent need to develop resources and guidelines to help e-cigarette users with quitting. There are concerns about e-cigarette users turning to their devices to quit. One particular concern is that of ongoing use. In studies that examined the efficacy of using e-cigarettes to quit smoking, although some users were able to successfully quit smoking, almost all were still vaping a year later [22,23], indicating that the use of e-cigarettes promoted ongoing addiction to nicotine compared with the use of approved pharmacological cessation support (eg, NRT).

Similar to this study, an analysis of >3000 Twitter tweets revealed that a gradual approach to quitting by JUUL users was popular, especially by tapering the nicotine concentration of their pods or changing their devices [24]. In contrast, adolescents in the study by Kong et al [25] used the cold turkey approach more frequently. This difference may be because of the length of nicotine product use, where adolescents may more easily quit cold turkeys because of a shorter timeline of use. The differences found indicate that guidelines and interventions should be tailored to different age groups, with attention to the time using nicotine products as well as the type of products used. The use of high-nicotine salt devices such as JUUL appears to lead to more intense addiction, which may make a cold turkey approach more difficult. The variability of nicotine concentration in vaping devices leads to complexity in relation to cessation, which is different from combustible smoking.

Reasons for Quitting

In this study, the most commonly cited reasons for quitting vaping were related to experiences of negative health consequences and addiction. Several studies reveal that experiencing negative health consequences and dependence are consistently among the top few reasons for quitting e-cigarettes [3,5,24,25]. Of particular note is the finding around current health effects. In an analysis of 2000 text responses to a question about reasons to quit vaping from the evidence-based e-cigarette cessation program for youth and young adults, “This is Quitting,” researchers found similar findings [3]. They found that the top-rated reason for quitting was health, especially current and general health, compared with future health [3]. The study by Ungar et al [24] also found that experiencing negative health consequences was the top-rated reason to quit. This reason to quit vaping, which is experiencing negative health consequences in the present, is different from the top-rated reason to quit combustible smoking, which is future health [26]. The fact that e-cigarette users are experiencing adverse health effects early in their vaping trajectory brings forward the need to pay more attention to the immediate health effects of vaping. There needs to be particular attention on the effect of vaping on the lungs given that users in this study primarily reported adverse pulmonary outcomes from vaping, including tight chest, sleep apnea, cough, wheezing, and breathlessness.

Barriers and Facilitators to Quitting

In this study, users reported intense withdrawal symptoms and dependency on high nicotine levels as the top barriers to quitting. This is not surprising given that the most popular e-cigarette devices enable the delivery of very high concentrations of nicotine to the brain (eg, JUUL is typically approximately 50 mg/ml) [27], the amount of nicotine that you would expect to see a heavy smoker consuming. These high-nicotine devices appear to be particularly problematic when trying to quit. This is not surprising given that the largest population of e-cigarette users are youth and young adults [28,29], those at an age when the brain is still developing [30,31], and that a developing brain is most vulnerable to long-term and intense nicotine addiction, which makes quitting much harder [27,31-33]. Countries such as Canada, which are taking a strong stance in limiting the nicotine concentration of e-cigarettes [34], are playing a critical role in protecting developing brains from early and long-term addiction. The findings of this study confirm that taking action to limit the nicotine concentration of these devices is critical. However, cessation services and advice must be reflective of the current state of use, which is when high-nicotine concentrations are allowed, as well as be ready to adapt to future use. Researchers should explore and evaluate how cessation advice and support may best accommodate shifts in use behaviors because of policy changes.

It is also interesting that not only offline interactions but also web-based interactions with other e-cigarette users served as a key barrier to quitting. Vaping has progressed in popularity at a time when social media use and social media influencers are rampant. e-Cigarette companies have successfully tapped into this trend and are not only lending to the uptake of e-cigarettes [35] but are also serving as a barrier to quitting, as revealed in this study. Vaping cessation efforts also need to capitalize on these web-based networks, and there are some innovative efforts being made in this regard (eg, This is Quitting by the Truth campaign) [7,36].

The findings also reveal that mental health challenges are a major barrier to quitting. Tobacco use is known to coincide with mental health issues, including among young adults [37]. Mental health disorders are increasing and are an urgent concern [38], especially in the context of the COVID-19 pandemic [39]. In light of this, attention to and screening for mental health among e-cigarette users is warranted. In addition, cessation interventions that promote positive mental health appear to align with stated facilitators to quitting, which include resiliency, self-grace, and self-love.

Another barrier to quitting is related to the accessibility of e-cigarettes. Vaping with nicotine is easily accessible via web-based sales [40], as well as the recent establishment of a large number of vape retailers that sell these products [41]. For example, in Canada, it was found that 76% of retail outlets sold vaping products in 2014 [42]. In the province of British Columbia alone, there are an estimated 90,000 vape retailers compared with only 6000 retailers that sell combustible cigarettes [43]. In addition, the policies around vaping are different from smoking; for example, you cannot be smoking indoors, but you can still vape in many indoor spaces despite several jurisdictions implementing vape-free indoor policies [44]. This is combined with the discreet and appealing designs of e-cigarettes and that e-cigarette users are left to their own devices to regulate their use. e-Cigarette advertising capitalizes on these freedoms associated with vaping and promotes users to use their vape at all times [45]. For example, a Blu commercial spends the entire 60 second advertising time to tell potential e-cigarette users that they can “smoke blue virtually anywhere” [46]. According to the users who posted on the Reddit community, being able to vape anywhere at any point in time has left them doing exactly that. This constant use has left them feeling “stuck to the vape” and is the primary reason for quitting. These findings have important implications for banning advertisements that promote vaping in this way, as well as policies for limiting where vaping can occur. The findings also hold implications in limiting the accessibility of both web-based and offline sales of e-cigarettes.

The top facilitator to quitting was the use of distractions, which ranged from things that kept the mind and hands busy to replacing the e-cigarette with other things, such as toothpicks and exercise. Similar to smoking cessation interventions such as Crush the Crave [47], the importance of including tips and opportunities to distract those who are trying to quit vaping is key. There is an opportunity for cessation interventions to capitalize on new digital technologies available to develop distractions for young vapers. Given that youth and young adults, the highest demographic of vapers, are ubiquitous on the web, focusing on innovative efforts in this context to help distract them through their cravings would likely prove quite fruitful, especially given their receptivity to receiving interventions for cessation through these media [5].

Future Research

These findings bring forward several areas for future research. First, the unique aspects of vaping cessation call for urgent research focused on developing cessation guidelines tailored to e-cigarette use. The development of these guidelines should establish both pharmacotherapy and behavioral support recommendations. For pharmacotherapy, it is interesting that a large portion of vapers used NRT to support their quit attempts, and they primarily used the nicotine patch and gum in tandem. There is a need to explore the right recipe for vapers who are trying to quit. This is especially critical, as the common use of high nicotine concentrations in e-cigarettes may mean that vapers need a different approach to NRT compared with smokers. For behavioral support interventions, the reported reasons for quitting, barriers and facilitators to quitting, and benefits of quitting could inform the development of interventions that resonate with vapers. Indeed, the findings offer a beginning framework and structure for exploring and developing recommendations.

Longitudinal research that tracks how cessation is approached is needed. It would be interesting to explore whether approaches to quitting shift over time with the introduction of new resources and policies. For example, whether fewer vapers resort to tapering their own devices to quit if pharmacotherapy options are tailored to vaping. It would also be interesting to conduct research on which facilitators are linked to successful long-term abstinence rates and for whom so that various populations have access to more tailored options to help them quit. Finally, there is a need to explore predictors of vaping so that we can identify high-risk populations before engaging in e-cigarette use.

Limitations

The findings of the study are based on data during a time when there was a pandemic, which may have influenced the experience of quitting. In addition, this study was conducted when few resources were available to support the cessation efforts of e-cigarette users. In addition, the findings are limited to data provided on one platform during a 4-week period. Another limitation of this study is the inability to definitively determine the demographic details of the Reddit community users, limiting the ability to note nuances in experiences and preferences based on demographic variables. However, Reddit users are known to skew toward being young and male [48], indicating that the results may represent the experiences of young males more than any other group. Finally, we could not determine how many users were still vaping and how many were vape free nor we could link particular facilitators to quitting success.

Conclusions

The findings of this study reveal the unique aspects that encompass the process of quitting vaping from the perspective of e-cigarette users. This work not only validates the need for more stringent policies around e-cigarette consumption and use but also brings forward some important gaps in relation to efforts to meet the needs of e-cigarette users who want to quit. The findings offer some recommendations and a beginning framework for steering e-cigarette policy and intervention efforts so that they resonate with e-cigarette users.