Two decades of electronic nicotine delivery systems discussions in Türkiye: AI-driven text analysis

Abstract Background As Turkiye ranks second in cigarette consumption in Europe, the increasing shift to Electronic Nicotine Delivery Systems (ENDS) presents emerging public health concerns. This study aims to introduce a hybrid approach by combining AI-driven large language models (LLM) with traditional thematic analysis to explore 20 years of ENDS discourse on Eksisozluk, a popular Turkish social media platform, using the Health Belief Model (HBM). Methods This mixed-methods study, analyzed 5,907 comments about ENDS from 2003 to 2023, sourced from a renowned online user-generated forum in Turkiye. Utilizing an LLM, comments were first categorized according to the HBM. Subsequently, the LLM’s generative capabilities were employed to identify sub-themes through thematic analysis. A temporal analysis was then conducted to examine the evolving trends over the 20-year span. Results ENDS popularity peaked in 2017, dipped during the COVID-19 pandemic, and later rebounded. Using an LLM with 70% accuracy, validated by a manually labeled sample, we discerned two main themes: perceived benefits (40.5%) - primarily using ENDS as for harm reduction (32.8%) and smoking cessation tools (21.6%)- and perceived barriers (27.7%), with cost and accessibility (21.9%) being the most significant throughout the period. Initially, the focus was on cessation, but shifted to harm reduction post-pandemic. Conclusions Our study indicates that consumers in Turkiye initially used ENDS for cessation but recognized their ineffectiveness over time. During the COVID-19 pandemic, usage shifted towards harm reduction, likely influenced by the rhetoric of the Tobacco Industry. Despite a national ban, ENDS remain widely used in Turkiye. Key messages • Turkiye should develop a social marketing strategy to raise awareness that ENDS is not a valid tool for harm reduction. • Although the sale of ENDS is prohibited in Turkiye, enforcement of bans should be strengthened as part of an effective control strategy.