{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T19:04:29Z","timestamp":1782846269676,"version":"3.54.5"},"reference-count":79,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tobacco harm reduction (THR) has become increasingly prominent in global tobacco discourse, with industry actors and advocates actively shaping messaging on social media platforms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to analyze how THR is discussed on X (formerly known as Twitter), examining message valence toward THR (pro, anti, mixed, or none), stakeholder participation, geographic and temporal variation, and the involvement of industry and THR advocates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a content analysis of 17,361 posts related to THR from 87 countries, published between July 2019 and December 2023. Thematic analysis was used to identify dominant narratives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Pro-THR posts comprised the majority (12,393\/17,361, 71.4%), followed by anti-THR (3925\/17,361, 22.6%) and neutral or mixed messages (63\/17,361, 0.4%). Pro-THR messages were most prevalent in high-income countries (9193, 78.3%) and were primarily disseminated by THR advocates (7084\/7426, 95.4%), tobacco users (3618\/3692, 98%), and industry-affiliated accounts (973\/1042, 93.3%). Anti-THR posts were more common among government entities (276\/333, 82.9%), tobacco control advocates (256\/364, 70.3%), and in lower-middle-income regions (149\/244, 61.2%). Self-identified health care providers represented 9.4% (1629\/17,361) of the dataset, with their posts nearly evenly split between pro-THR (716\/1629, 44%) and anti-THR (826\/1629, 50.7%) narratives. Pro-THR narratives emphasized the safety and smoking cessation potential of newer nicotine and tobacco products, consumer rights, and skepticism toward public health authorities. In contrast, anti-THR messages focused on youth protection, health risks of newer products, distrust of industry motives, and advocated for complete cessation of tobacco and nicotine use. Notably, 39.6% (6881\/17,361) of THR-related posts mentioned newer products, and 15.7% (2724\/17,361) included marketing efforts. There was a marked increase over time in overall THR-related post volume, posts by THR advocates, product mentions, and marketing attempts. Overall, high-income countries contributed the majority of posts (11,739\/17,361, 67.6%) while nearly half originated from North America (8553\/17,361, 49.3%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The online discourse surrounding THR is characterized by a predominance of pro-THR messaging, particularly in high-income countries and among industry-affiliated stakeholders. The growing volume of THR advocacy and marketing efforts on social media presents new challenges for tobacco regulation and public health policy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/77676","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T21:52:11Z","timestamp":1762206731000},"page":"e77676-e77676","source":"Crossref","is-referenced-by-count":0,"title":["Message Valence, Industry Influence, and Stakeholder Narratives in Global Conversations on Tobacco Harm Reduction: Content Analysis"],"prefix":"10.2196","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0720-7122","authenticated-orcid":false,"given":"Jungmi","family":"Jun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9500-6349","authenticated-orcid":false,"given":"Ali","family":"Zain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7715-6826","authenticated-orcid":false,"given":"Minji","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6418-4863","authenticated-orcid":false,"given":"James","family":"Thrasher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,11,3]]},"reference":[{"key":"R1","unstructured":"Tobacco harm reduction. 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