#toolittletoolate: JUUL-related content on Instagram before and after self-regulatory action

Introduction Digital e-cigarette marketing is largely unregulated and remains easily accessible to young people. The growing public concern around youth JUUL use and its viral presence on social media led the company to engage in several voluntary actions to remove and reduce JUUL-related content on Instagram in May 2018. The current study examined how JUUL-related Instagram content changed in the US following JUUL Labs' wave of voluntary actions in May 2018. Methods In 2019, we collected a total of 50,817 JUUL-relevant posts by 16,323 unique users on Instagram from March 1-May 15, 2018 (Phase 1) and May 16-November 11, 2018 (Phase II) using the application programming interface. We conducted a semantic network analysis to identify major topic clusters over time. Results Approximately 14,838 JUUL-related posts were made by 5,201 accounts in Phase I and 35,979 posts were made by 11,122 accounts in Phase II. Major content clusters remained unchanged over time-key topics were JUUL-related product characteristics and JUUL-communities; the general vape community; and cannabis-related behavior. Of note, cannabisrelated content grew in Phase II, particularly use of the term CBD. Conclusions Our results reflect the limits of voluntary industry actions to reduce or change vaping-related content on social media. Rather, strong federal restriction on commercial tobacco marketing is the optimal pathway to reduce initial product marketing exposure among youth. These limits would make the emergence and viral contagion of brand-related social media content less likely and reduce its influence on youth behavior.