Instagram's #JUUL: who's posting what.

Exposure to e-cigarette (e-cig) marketing through traditional and online media can increase the risk of e-cig use among adolescents. Though popular e-cig brand JUUL has scaled back its social media promotions, outside vendors and individual users create posts about JUUL unregulated. Instagram's image-focus offers an opportunity to document promotions that may appeal to adolescents. To assess the visual representation of JUUL on social media, we systematically classified discussion topics and themes of posts to Instagram. Of 25,428 unique Instagram images using the hashtag #JUUL retrieved between June 18 and July 18, 2018, a random subsample of 3,000 images (approximately 12% of the full data set) was drawn for human coding and analyses. Coded categories included relevance to JUUL, type of image, image appeal, and user type. Based on the number of relevant images, percentages of image type and appeal for each user type were calculated. There were 583 images that were coded as relevant. The majority of image types (64%) were classified as product (n =; 374). The most frequently coded type of appeal was flavors, found in 54% of images with appeal (n =; 149), followed by cartoons, found in 21% (n =; 57). Vendors were responsible for posting most of the images (n =; 291), followed by e-cig enthusiasts (n =; 99). Continued surveillance of e-cig products, such as JUUL, remains necessary to provide a foundation for potential regulatory protections against marketing and promotions that may appeal to youth.