To Tweet or Not to Tweet: Tweets About Tobacco Regulation can Help Disseminate Anti-regulatory Messages.

This article examines how the U.S. Food and Drug Administration's (FDA) use of Twitter to communicate about the Premarket Tobacco Product Application (PMTA) process for e-cigarettes led to disproportionate amplification of anti-policy sentiment. Analyzing 52 FDA tweets and their 711 replies and 155 quote tweets from July to November 2021, the study found that 96.7% of replies and 77.9% of quote tweets opposed the PMTA policy, with anti-policy content receiving significantly more likes and retweets than pro-policy messages. The research highlights how Twitter's interactive features, especially quote tweets, enable opponents to repurpose FDA messages into persuasive counterarguments based on Inoculation Theory, thereby undermining regulatory communication efforts. The findings suggest that public health organizations should carefully consider the risks of engaging on Twitter and develop strategies to monitor and respond to hostile counter-messaging to better support tobacco control objectives.