Using Online Listening Tools to Analyze Social Media Discourse about and Among Pregnant Smokers

Background: Approximately 8.4% of women report smoking during pregnancy, however, stigma may prevent women from seeking support to quit. Conversations taking place online – where pregnant women may be more likely to express themselves anonymously – can offer new insights into the challenges they face. Moreover, online dialogue provides a way of rapidly assessing public sentiment regarding smoking during pregnancy, which may influence the experiences of pregnant smokers.

Program background:  In 2009 we conducted an environmental scan of social networking sites targeting pregnant women, to inform the National Cancer Institute’s Smokefree.gov mHealth smoking cessation program content for pregnant smokers. Prominent themes in these conversations included misinformation/myths relating to the health effects of smoking while pregnant, and shaming by nonsmokers. To update this scan, we used Crimson Hexagon’s ForSight social listening platform to identify trends in online dialogue relating to smoking during pregnancy on publicly available forums.

Evaluation Methods and Results: Keywords relating to smoking during pregnancy were added to the Crimson Hexagon monitor to identify relevant posts from January 1, 2010 through May 15, 2015. We chose keywords based on the environmental scan of social media accounts and online forums; commonly used words (smoking, pregnancy) were added first. Words continued to be added to the monitor as we came across new terms that appeared to be a part of the lexicon, until no new data was being collected by the monitor. The search string included personal pronouns (“I” or “me”), words for “pregnant,” and words for “smoking.” We examined the raw data and trained the Crimson Hexagon algorithm to collect all relevant conversations. The monitor then generated data visualizations showing common language, and we conducted a qualitative content analysis of posts to identify themes appearing in online conversation. Search parameters produced 23,483 posts containing some variation of the keywords. Similar to results in the original environmental scan, many smoking mothers expressed feelings of guilt for smoking, and anticipation of harsh feedback when seeking cessation support. Many conversations also point to misconceptions about smoking while pregnant (e.g., withdrawal symptoms from quitting can harm the baby). Since 2011, mentions of e-cigarettes in conversations about smoking during pregnancy increased.  

Conclusions:  Online discussions highlight misconceptions about the health effects of smoking while pregnant, stigmatizing online experiences for pregnant women, and more recent trends of using e-cigarettes as cessation tools during pregnancy. Results underscore the value of health campaigns that offer content tailored to the unique challenges pregnant smokers are faced with.

Implications for research and/or practice:  Social media listening tools, like Crimson Hexagon, can provide insights into public dialogue around stigmatized topics (e.g., pregnant smoking), and can be used to inform efforts to reach specific audiences. Understanding current attitudes around pregnant smokers and barriers to quitting is a crucial step to creating timely, relevant cessation content for this demographic. Moreover, given that conversations online continue to stigmatize pregnant smokers, it may be important to offer content that addresses stigma head-on, rather than solely focusing on fetal health.