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J Med Internet Res. 2019 Jun 4;21(6):e12676. doi: 10.2196/12676.

Tobacco Use Behaviors, Attitudes, and Demographic Characteristics of Tobacco Opinion Leaders and Their Followers: Twitter Analysis.

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University of Pittsburgh, Pittsburgh, PA, United States.
University of Southern California, Los Angeles, CA, United States.
Contributed equally



Tobacco-related content on social media is generated and propagated by opinion leaders on the Web who disseminate messages to others in their network, including followers, who then continue to spread the information. Opinion leaders can exert powerful influences on their followers' knowledge, attitudes, and behaviors; yet, little is known about the demographic characteristics and tobacco use behavior of tobacco opinion leaders on the Web and their followers, compared with general Twitter users.


In this study, we hypothesized that opinion leaders use more tobacco products and have higher nicotine dependence than the other 2 groups (eg, followers and general Twitter users) and that followers-those who spread messages by opinion leaders-would more likely be in demographic groups that are vulnerable to tobacco marketing influence (eg, young adults and lower educational attainment).


We constructed the social networks of people who tweet about tobacco and categorized them using a combination of social network and Twitter metrics. To understand the characteristics of tobacco opinion leaders and their followers, we conducted a survey of tobacco opinion leaders, their followers, and general Twitter users. The sample included 347 opinion leaders, 567 followers, and 519 general users. The opinion leaders had a median of 1000 followers, whereas followers and general users had fewer than 600 followers.


Opinion leaders were more likely than their followers to report past month use of tobacco products; followers, in turn, were more likely to report past month use of these products than general Twitter users. The followers appeared to be an especially vulnerable group; they tended to be younger (mean age 22.4 years) and have lower education compared with the opinion leaders and general users.


Followers of Twitter tobacco opinion leaders are a vulnerable group that might benefit from antitobacco education to counter the protobacco communications they see on social media.


online social networking; peer influence; social media; social networking; tobacco

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