To help address this we did include substance use disorder in estimating substance use among adults with chronic diseases.College-going individuals in the United States may have unique attitudes toward substance use behavior and tobacco use, including shifts in attitudes and behaviors that are associated with the constantly changing product landscape of alternative tobacco products , such as electronic-cigarettes . Psychosocial behaviors and campus culture, including class attendance, peer socializing, campus policies, and residential environments, may also facilitate these unique attitudes toward favorability of smoking among college subgroups, while also introducing a unique risk environments for tobacco initiation, uptake, transition, and use . In addition, part of the variation explaining these health behaviors may be influenced by the specific demographic and socioeconomic characteristics of a college campus population and community. Data from social media platforms are often used to self-report and publicly communicate health-related attitudes and behaviors . Young adults [ages 18–25 ] in the United States are much more likely than older populations to actively use social media, including popular platforms Twitter, Snapchat, and Instagram . Infoveillance research, which uses online information sources to detect trends about the distribution and determinants of disease, including health knowledge and behaviors, has been used to develop insights on numerous public health issues including infectious diseases, vaccination sentiment, opioid use disorder, mental health issues, and, relevant to the exploratory aims of this study, tobacco and alternative tobacco use attitudes and behavior . However, smoking-related discussions on social media tied to specific colleges with geographic specificity has not been widely investigated. Existing studies using social media to examine tobacco-related attitudes and behaviors in college aged populations have primarily focused on evaluating the impact of social media health promotion anti-tobacco campaigns,commercial greenhouse supplies recruiting hard-to-reach college populations using social media platforms, and examining the influence of exposure to tobacco-related social media content and marketing on current and future behavior and use .

Other research on college-aged populations has focused on assessing tobacco initiation and transition of use patterns, particularly as new alternative and emerging tobacco products become available . Accelerating research using social media to assess tobacco-related attitudes/influences among youth has also been supported by U.S. Federal initiatives, including projects funded by the National Cancer Institute and U.S. Food and Drug Administration Tobacco Centers of Regulatory Science, which for have identified and characterized e-cigarette advertisements on image-focused social media sites and tobacco user experiences with little cigars and e-cigarettes as discussed on Twitter . Changes in local, state, and national health policy related to tobacco and other products smoked or used concurrently with tobacco and electronic cigarettes can also have an impact on attitudes and behaviors of these populations. For example, recent debate in the United States regarding the legalization of marijuana/cannabis may positively influence marijuana-related attitudes for college populations, who tend to skew toward more liberal policies regarding decriminalization, legalization, and increased access . Similarly, the 2019 outbreak of e-cigarette and vaping-related lung injury associated with products containing tetrahydro cannabinol may dissuade tobacco or THC use in certain young adult populations, particularly since they were most heavily impacted by the disease . Examining the changing public attitudes and behaviors of college-aged smokers is particularly salient for the State of California, USA. As of January 2014, all campuses in the statewide University of California system became tobacco free , and the California State University system followed suit in 2017 . In addition, voters in California approved Proposition 56 in late 2016, which added a $2.00 increase to the cigarette tax effective April 2017, with an equivalent increase on other tobacco products and electronic cigarettes . Voters in 2016 also approved Proposition 64, which legalized the use of recreational cannabis in November 2016 . During this time, the popularity of e-cigarettes in the United States was increasing .

These changes in policy and preferences underscore the interconnected nature of the Triangulum of tobacco products , including potential for dual-use, transition between products, and challenges associated with conducting surveillance and implementing cessation programs . This changing policy landscape supporting tobacco control measures, as reflected in the shift of California’s public university systems to become smoke-free, is a key impetus for this study. The ability of these colleges to eliminate on-campus smoking relies in large part on understanding past and existing knowledge and attitudes held by the campus smoking populations, along with their perceptions and behaviors that may be associated with compliance or non-compliance to smoke free campus policies. In response, this study conducted exploratory research on the popular micro-blogging platform Twitter. specifically, we used big data, data mining, and geospatial approaches to identify and characterize tweets originating from Twitter users specifically geolocated at California 4-year university campuses. Our primary objective was to assess types of tobacco and ATP products mentioned by users, the distribution of user sentiment toward tobacco and smoking behavior, and to assess the feasibility of detecting self-reported smoking behavior that may represent a violation of campus smoke free policies. Secondarily, we also sought to conduct a cross-campus assessment to determine how these factors vary across different university and college communities and over time. The objective of the study’s data collection approach was to obtain a highly refined subset of tweets, which were both posted from college campus’ geolocated coordinates in California and also included user discussions about smoking, in preparation for manual review to more purposefully identify tweets that specifically discussed different types of tobacco and smoking products, sentiment of users toward smoking behavior, and self-reported smoking behavior on campus.

Data were collected from the Twitter public streaming Application Programming Interface using the cloud-computing service Amazon Web Services . The public streaming API was set with fifilters to collect all tweets that included metadata containing latitude and longitude coordinates, initially with no filter for keywords. Tweets were collected continuously from 2015 to 2019. All tweets collected included the text of the tweet and associated metadata, including the date and time of tweets. The use of the public Twitter streaming API to collect data pre-filtered only for tweets including latitude and longitude coordinates represent a subset of all tweets posted during the time frame of the study. There exists the potential for sampling bias associated with different Twitter APIs that are not representative of all Twitter data , and data filtered only for geocoded data may omit many conversations from college aged populations about topics, such as smoking, which may be linked to college-related user groups . Though resulting in a much smaller volume of data, our approach nevertheless allows for detection of tweets in specific geospatial bounds at the high resolution of latitude and longitude coordinates in the state of California. Therefore, by using this data collection approach, we were able to isolate tweets originating from geospatial coordinates within the formal spatial boundaries of all 4-year universities in California. To enable this geolocation, a basemap of California 4-year universities from the Stanford Prevention Research Center was obtained and cross-referenced. Tweet geolocated points were spatially joined to campus polygons using ArcGIS software.College areas were comprised of multiple polygons for different campuses and associated properties,cannabis dry rack though aggregation was conducted at the overall college level to enable comparison across different colleges. Tweets were then filtered for 37 keywords which were broadly related to tobacco-related topics, including the names and brands of different tobacco and ATPs and descriptive terms associated with smoking and vaping as expanded upon from those used in prior studies . specifically, the following keywords were used: bidis, cigarette, cigarettes, cigarillos, cigars, cigie, class, dip, e-cig, hookah, huqqa, joint, JUUl, kereteks, Marlboro, Newport, njoy, pipe, roll-up, shag, smoke, smoking, snuff, snus, tobacco, vape, vaped, vapejuice, vaper, vapes, vaping, vapor, water pipe, waxpen, and weed. The purpose of this keyword filtering was to better isolate smoking-related conversations from all other Twitter discussions occurring on college campuses. After tweets were manually reviewed to positively identify smoking-related conversations originating in these college campuses, a snowball sampling design was employed which compared the frequency of all non-keyword terms in “signal” tweets with the frequency of these words in “noise” tweets .

This methodology resulted in the identification and querying for ten additional keywords: 420, 818, blunt, bong, cigs, kush, marijuana, roll, smell, and stoge. Based on our use of tweets specifically geolocated for CA 4- year universities combined with a data filtering process to isolate tweets containing smoking-related keywords, 7,342 tweets were obtained for analysis that discussed smoking and also originated from California universities between 2015 and 2019. Within this corpus of social media messages, rates for use of the term “weed” decreased over time, changing from 28% in 2015 to 7% in 2019. Other commonly used smoking-related terms did not exhibit a percentage drop of this magnitude. The mechanisms underscoring the observed decrease in social media messages with this keyword are not clear but may result from evolving word choices to describe marijuana, decreased use of marijuana on CA college campuses, social inhibition of posting marijuana related public messages on Twitter, or some combination thereof. Further, it is unclear how passage of legalized adult-use cannabis Proposition 64 may have impacted these conversations, attitudes, and behaviors, particularly as despite state legalization, some college-aged students may not be of legal age and campus smoke free policies still restrict their use. Manual review uncovered 1,089 tweets explicitly related to smoking behavior and posted within the boundaries of California 4-year universities, with the majority of tweets expressing positive sentiment about smoking products and behavior. Five-hundred and-two of these tweets reported first-person use or secondhand observation of another person’s smoking behavior, with 146 tweets reporting possible violations of smoke- or tobacco free campus policies that were clearly in place from 2015 but were also in the process of being fully implemented. These tweets indicate early lack of compliance to smoke-free campus policy implementation as self-reported by social media users. For campuses where policies were not in place, tweets also reflect general positive sentiment about smoking and reports of smoking behavior, indicating possible barriers to enacting campus smoke free policies that would occur in 2017, when more smoke free campus policies across the California State University system were enacted. These results provide early indications that smoke free campus policy implementation requires continued attention and sufficient resources to ensure appropriate health promotion, education on policy requirements, and policy enforcement measures in college communities. Overall, our analysis found a higher number of tweets in our corpus identified for tobacco and marijuana products, with comparatively fewer for vaping products geolocated for California university campuses. The majority of geolocated data collected during this study originated in 2015, which may explain the overemphasis on tobacco and marijuana Twitter conversations as vaping products were rising in popularity. Additionally, national debate about marijuana legalization occurred during this time frame, though was not legalized in California for adult recreational use until 2016 and licensure of cannabis retailers was permitted in 2018. As previously stated, national and state discussions relating to marijuana legalization may have influenced the relative social acceptability and volume of marijuana-related Twitter conversations among campus populations. Tweets about vaping had the highest proportion containing first-hand accounts of use or other persons engaged in product use and behavior. The increasing popularity of vaping products throughout the study time period, especially among the college aged population, may partly explain why college students posted about themselves or other people using vaping products in this context, despite having an overall lower volume than other smoking products . The increasing use of more discreet forms of vaping, particularly JUUL , may also have had an impact on social media engagement about vaping behavior, though more research is needed. Also, the associated health risks of vaping were relatively unknown during the study period, though the outbreak of EVALI in 2019 may have generated more attention and possible concern among users about potential health risks of vaping, though these conversations were not detected in this study . Importantly, most tweets that included conversations about tobacco products and behavior expressed positive sentiment. Though unclear from these preliminary results, the influence of “party culture” on college campuses, the opportunities to experiment and initiate with forms of substance abuse behavior, and the immediacy of pleasure from substance use may outweigh concerns, including those relating to long-term health risks, among college students in the United States as observed in this user sentiment .