Analysis of newspaper coverage of electronic cigarettes in Hong Kong from January 2010 to May 2015

Background: The public awareness and use of the electronic cigarette (EC) has increased rapidly in Hong Kong (HK). ECs are promoted as safe and healthier alternatives to conventional cigarettes or as a smoking cessation aid. In addition, EC marketing targets the youth population, making the product a potential gateway to cigarette smoking. This may cause future threats to public health. News media are very powerful in shaping the public’s perception. However, studies examining the presentation of ECs in media coverage were only conducted in foreign countries. This study aimed to investigate the content in newspaper coverage of ECs in HK. Methods: In collaboration with the Hong Kong Council on Smoking and Health, data was collected from its database “Wisers”, which covers all major newspapers in HK. The terms “電子煙”, "e-cigarette / e cigarette", "electronic cigarette", "electronic nicotine delivery systems" and "ENDS" were used to search English and Chinese newspapers published from 1 January 2010 to 31 May 2015. A total of 348 articles (44 English, 304 Chinese) were located. 18 online and printed articles (12 English, 6 Chinese) were excluded from the analysis because of duplication, and 8 online articles (3 English, 5 Chinese) were excluded due to incompletion. Finally, a total of 322 articles (28 English, 294 Chinese) were analyzed in the present study. Of the 322 articles, 69 were published in online newspapers and the remaining 253 in printed newspapers. A content analysis was conducted to generate themes. Articles were coded independently by two coders according to the coding guide. Cohen’s kappa (k) was used to check inter-coding reliability and the k values was found to range from 0.91 to 1, which indicated a high level of agreement between the coders. This was followed by a quantitative method on counting the frequency of messages and themes. Results: A massive increase in the EC coverage of both printed and online newspaper articles was observed. Only 10 to 15 printed articles appeared each year from 2010 to 2012. However, its coverage increased rapidly, with 53 printed articles in 2013, 68 in 2014, and 96 in the first five months of 2015 alone. Online newspapers were included in “Wisers” since April 2014. EC coverage in online articles clearly increased, from 19 in the 9 month period in 2014 (1 April - 31 December) to 50 in the five month period in 2015 (1 January - 31 May). The six themes developed were: (1) EC regulations (77%, 247/322); (2) health related issues: health effects on the EC user (50%, 159/322); health influence on others (11%, 34/322); (3) addiction (47%, 150/322); (4) smoking cessation and reduction (26%, 84/322); (5) marketing behavior and strategy of EC industry (49%, 158/322) and (6) public health debates on ECs (3%, 10/322). Conclusions: The coverage of ECs had increased in HK’s newspapers from 1 January 2010 to 31 May 2015. This trend conveyed the growing interest and awareness of ECs as a public health concern. Findings from this study may help develop public health campaigns and interventions to better inform policy makers and the public about ECs.published_or_final_versionPublic HealthMasterMaster of Public Healt