Tweeted, Trolled, Twisted: Battling for Narrative Control in E-Cigarette Use Prevention Campaigns (2014-2020).

This study identifies and analyzes X (formerly Twitter) posts related to 14 e-cigarette use prevention campaigns from 2014 to 2020, assessing message volume, content, sources, potential reach and engagement. Using supervised machine learning, we classified 618,965 tweets, finding 43% contained opposition messaging. Two regional campaigns received the highest levels of opposition, with over 99% of related tweets classified as opposition. However, prevention/neutral messages exhibited 92% higher potential reach than opposition messages. Geolocation analysis suggested that regional campaigns may have struggled to focus their impact within targeted jurisdictions. These findings illustrate the dual role of social media as both an amplifier of prevention messages and a platform for oppositional narratives, underscoring the need for public health practitioners to develop adaptive strategies to enhance the impact of digital campaigns.