On 2017 Aug 05, Jon-Patrick Allem commented:

There are at least five problems with this paper: First, the authors simply assume that the pro-e-cigarette tweets are wrong and need their corrective input. What if users are right to be positive? The authors have not demonstrated any material risk from vapour aerosol. To the extent that there is evidence of exposure the levels so low as to be very unlikely to be a health concern. The presence of a hazardous agent does not in itself imply a risk to health, there has to be sufficient exposure to be toxicologically relevant.

This critique is misguided. The goal of this paper was to characterize public perception of e-cigarette aerosol by using a novel data source (tweets) and not to demonstrate any material risk from e-cigarette aerosol.

Second, they have also not considered what harmful effect that their potentially misleading 'health education messages' may have. For example, by exaggerating a negligible risk they may be discouraging people from e-cigarette use, and potentially causing relapse to smoking and reducing the incentive to switch - thus doing more harm than had they not intervened. We already know the vast majority of smokers think e-cigarettes are much more dangerous than the toxicological profile of the aerosol suggests - see National Cancer Institute HINTS data. The authors' ideas would aggravate these already highly damaging misperceptions of risk.

This critique is misguided. This study did not design educational messages. It described people’s perceptions about e-cigarette aerosol.

Third, as so often happens with tobacco control research, the authors make a policy proposal for which their paper comes nowhere close to providing an adequate justification. Public health and regulatory agencies could use social media and traditional media to disseminate the message that e-cigarette aerosol contains potentially harmful chemicals and could be perceived as offensive. They have not even studied the effects of the messages they are recommending on the target audience or tested such messages through social media. If they did, they would discover that users are not passive or compliant recipients of health messages, especially if they suspect they are wrong or ill-intentioned. Social media creates two-way conversations in which often very well-informed users will respond persuasively to what they find to be poorly informed or judgemental health messages. Until the authors have tested a campaign of the type they have in mind, they have no basis for recommending that agencies spend public money in this way.

This critique is misguided. There was no policy proposal made in the passage highlighted here. The suggestion that social media platforms can be used as a communication channel is not a policy. It is a communication strategy. The idea that social media can be used to obtain information and later communicate messages is completely in line with the work presented in this paper. The notion that every paper answers every research question pertaining to a topic is an unreasonable expectation.

Fourth, the authors suggest that users should be warned by public health agencies that "e-cigarette aerosol ... could be perceived as offensive". If there were warnings from public health and regulatory agencies about everything that could be perceived as offensive by someone, then we would be inundated with warnings. This is not a reliable basis or priority for public health messaging. Given the absence of any demonstrable material risk from e-cigarette aerosol, the issue is one of etiquette and nuisance. This does not require government intervention of any sort. Vaping policy in any public or private place should be a matter for the owners or managers, who may not find it offensive nor wish to offend their clientele. It is not a matter for legislators, regulators or health agencies.

This critique here is based on one’s own opinion about the role of government and could be debated with no clear stopping point.

Fifth (and with thanks to Will Moy's tweet), the work is pointless and wasteful. Who cares what people are saying on twitter about e-cigarettes and secondhand aerosol exposure? Why is this even a subject worthy of study and what difference could it make to any outcomes that are important for health or any other policy? What is the rationale for spending research funds on this form of vaguely creepy social media surveillance? Updated 21-Jan-17 with fifth point.

Big social media data (Twitter, Instagram, Google Webs Search) can be used to fill certain knowledge gaps quickly. While one study using one data source is by no means definitive, one study based on timely data can provide an important starting-off point to address an issue of great import to public health. This paper describes why understanding public sentiment toward e-cigarette aerosol is relevant and utilizes a data source that allowed people to organically report on their sentiment toward e-cigarette aerosol unprimed by a researcher, without instrument bias, and at low costs. Also, policy development and communication campaigns are two distinct areas of research. The goal of this study was to inform the latter.

On 2017 Jan 25, Erica Melief commented:

None

On 2017 Jan 21, Clive Bates commented:

There are at least five problems with this paper:

First, the authors simply assume that the pro-e-cigarette tweets are wrong and need their corrective input. What if users are right to be positive? The authors have not demonstrated any material risk from vapour aerosol. To the extent that there is evidence of exposure the levels so low as to be very unlikely to be a health concern. The presence of a hazardous agent does not in itself imply a risk to health, there has to be sufficient exposure to be toxicologically relevant.

Second, they have also not considered what harmful effect that their potentially misleading 'health education messages' may have. For example, by exaggerating a negligible risk they may be discouraging people from e-cigarette use, and potentially causing relapse to smoking and reducing the incentive to switch - thus doing more harm than had they not intervened. We already know the vast majority of smokers think e-cigarettes are much more dangerous than the toxicological profile of the aerosol suggests - see National Cancer Institute HINTS data. The authors' ideas would aggravate these already highly damaging misperceptions of risk.

Third, as so often happens with tobacco control research, the authors make a policy proposal for which their paper comes nowhere close to providing an adequate justification.

Public health and regulatory agencies could use social media and traditional media to disseminate the message that e-cigarette aerosol contains potentially harmful chemicals and could be perceived as offensive.

They have not even studied the effects of the messages they are recommending on the target audience or tested such messages through social media. If they did, they would discover that users are not passive or compliant recipients of health messages, especially if they suspect they are wrong or ill-intentioned. Social media creates two-way conversations in which often very well-informed users will respond persuasively to what they find to be poorly informed or judgemental health messages. Until the authors have tested a campaign of the type they have in mind, they have no basis for recommending that agencies spend public money in this way.

Fourth, the authors suggest that users should be warned by public health agencies that "e-cigarette aerosol ... could be perceived as offensive". If there were warnings from public health and regulatory agencies about everything that could be perceived as offensive by someone, then we would be inundated with warnings. This is not a reliable basis or priority for public health messaging. Given the absence of any demonstrable material risk from e-cigarette aerosol, the issue is one of etiquette and nuisance. This does not require government intervention of any sort. Vaping policy in any public or private place should be a matter for the owners or managers, who may not find it offensive nor wish to offend their clientele. It is not a matter for legislators, regulators or health agencies.

Fifth (and with thanks to Will Moy's tweet), the work is pointless and wasteful. Who cares what people are saying on twitter about e-cigarettes and secondhand aerosol exposure? Why is this even a subject worthy of study and what difference could it make to any outcomes that are important for health or any other policy? What is the rationale for spending research funds on this form of vaguely creepy social media surveillance?

Updated 21-Jan-17 with fifth point.

On 2017 Jan 21, Clive Bates commented:

There are at least five problems with this paper:

First, the authors simply assume that the pro-e-cigarette tweets are wrong and need their corrective input. What if users are right to be positive? The authors have not demonstrated any material risk from vapour aerosol. To the extent that there is evidence of exposure the levels so low as to be very unlikely to be a health concern. The presence of a hazardous agent does not in itself imply a risk to health, there has to be sufficient exposure to be toxicologically relevant.

Second, they have also not considered what harmful effect that their potentially misleading 'health education messages' may have. For example, by exaggerating a negligible risk they may be discouraging people from e-cigarette use, and potentially causing relapse to smoking and reducing the incentive to switch - thus doing more harm than had they not intervened. We already know the vast majority of smokers think e-cigarettes are much more dangerous than the toxicological profile of the aerosol suggests - see National Cancer Institute HINTS data. The authors' ideas would aggravate these already highly damaging misperceptions of risk.

Third, as so often happens with tobacco control research, the authors make a policy proposal for which their paper comes nowhere close to providing an adequate justification.

Public health and regulatory agencies could use social media and traditional media to disseminate the message that e-cigarette aerosol contains potentially harmful chemicals and could be perceived as offensive.

They have not even studied the effects of the messages they are recommending on the target audience or tested such messages through social media. If they did, they would discover that users are not passive or compliant recipients of health messages, especially if they suspect they are wrong or ill-intentioned. Social media creates two-way conversations in which often very well-informed users will respond persuasively to what they find to be poorly informed or judgemental health messages. Until the authors have tested a campaign of the type they have in mind, they have no basis for recommending that agencies spend public money in this way.

Fourth, the authors suggest that users should be warned by public health agencies that "e-cigarette aerosol ... could be perceived as offensive". If there were warnings from public health and regulatory agencies about everything that could be perceived as offensive by someone, then we would be inundated with warnings. This is not a reliable basis or priority for public health messaging. Given the absence of any demonstrable material risk from e-cigarette aerosol, the issue is one of etiquette and nuisance. This does not require government intervention of any sort. Vaping policy in any public or private place should be a matter for the owners or managers, who may not find it offensive nor wish to offend their clientele. It is not a matter for legislators, regulators or health agencies.

Fifth (and with thanks to Will Moy's tweet), the work is pointless and wasteful. Who cares what people are saying on twitter about e-cigarettes and secondhand aerosol exposure? Why is this even a subject worthy of study and what difference could it make to any outcomes that are important for health or any other policy? What is the rationale for spending research funds on this form of vaguely creepy social media surveillance?

Updated 21-Jan-17 with fifth point.