Vaping associated with healthy food words: A content analysis of Twitter.

E-cigarettes were initially introduced as a less harmful alternative to combustible cigarettes, but marketing efforts may now be exceeding these claims by associating e-cigarettes with words related to healthy foods. These associations could mislead people to assume vaping is a healthy practice. Tweets from January to March 2017 were obtained from the Twitter Streaming Application Programming Interface (API) to assess content about vaping linked to healthy food words. Tweets were classified into one of nine categories along with their source (marketer vs. non-marketer). We content analyzed original English language public postings on Twitter that included vaping-related keywords and at least one of eight co-occurring healthy food-related labels (e.g., 'natural,' 'vitamin,' 'vegan,' and 'organic') ( N  = 1205). Chi-square analyses compared themes by message source. Findings suggest vaping is being marketed in ways that could paradoxically lead consumers to believe that e-cigarettes are health-enhancing. We found more tweets representing vaping as health-enhancing (9%) than referring to it as a smoking-cessation device (1%). The largest category of tweets referred to vaping as harmless (28%) and therefore compatible with a healthy lifestyle. Tweets presenting vaping as harmless or with a sensation theme were more likely to be authored by marketers than by non-marketers. Food and drug regulation needs to be more vigilant to prevent misleading advertising from e-cigarette marketers.