US study analyzes joint marketing of heated tobacco and alcohol on social media

The World Health Organization (WHO) describes the commercial determinants of health as the actions of industrial actors that influence the health of populations, particularly through their marketing strategies. The tobacco industry, often cited as a central example, constantly adapts its products and promotional practices to circumvent regulations. On social media, where regulatory oversight remains limited, heated tobacco is frequently associated with alcohol, which contributes to normalizing their joint use. This study, conducted by the University of Chicago, Illinois, aims to analyze the presence and content of tobacco messages., particularly those associating them with alcohol published on X (formerly Twitter), to characterize their main themes and to identify the sources of diffusion[1].

A study based on the analysis of a large number of highly organized promotional accounts

The researchers collected more than 1.3 million tweets related to heated tobacco between August 2016 and October 2021, published in the United States and in English. After automated filtering and classification, 777,336 relevant tweets were retained. Of these, 36,804, or 4.7 billion, contained references to alcohol.

A thematic analysis was conducted on a representative sample, distinguishing four main categories of content: culture and lifestyle (rural identity, social codes around alcohol and tobacco), concomitant consumption (simultaneous use of tobacco and alcohol), alcohol-flavored products and risk comparisons (tobacco versus alcohol).

The accounts were categorized into three groups: commercial (e.g., heated tobacco brands, their manufacturers, seller accounts promoting heated tobacco products and accessories such as spittoons), automated accounts (“bots”), and ordinary user accounts.

The analysis showed that content related to culture and lifestyle largely dominated (71.8 %), followed by references to joint consumption (14 %) and alcoholic aromas (4.3 %).

Additionally, business accounts accounted for only about 1.1T of the profiles but produced nearly 5.1T of the tweets. Some of them shared identical messages, suggesting coordinated activities.

Commercial accounts had a higher average number of followers (6,080) than bot accounts (3,442) and user accounts (1,326).

Thus, bots contributed 4 % of the content, commercial and automated accounts had on average a higher number of followers than ordinary accounts, allowing them a disproportionate reach. A peak of activity was noted in August 2018 coming from a stigmatizing viral tweet, which generated nearly half of the publications in the corpus. Indeed, it joked about an image by saying that it " smells of cigarettes, moonshine, chewing tobacco and incest "These viral negative stereotypes can paradoxically reinforce group identity among tobacco and chewing tobacco users. According to the study's authors, this is an important element to consider when analyzing marketing strategies aimed at rural communities and in health communications aimed at them.

Protecting young people from aggressive and targeted marketing

The study highlights co-promotion strategies where heated tobacco is associated with alcohol through cultural narratives, particularly those related to the rural identity of “country” and “cowboys,” often associated with values such as authenticity, self-reliance, and connection to nature and manual labor, masculinity, and “drinking culture.” By strategically associating heated tobacco and alcohol with these core values, marketing discourses construct a version of rural masculinity where substance use is presented as a normal, even essential, component of this identity.

This co-promotion serves to anchor both products in this constructed cultural discourse, making it difficult for individuals to separate substance use from the identity they value.

The significant role played by a small number of commercial and automated accounts suggests an organized amplification of messages. Conversely, prevention and withdrawal messages are rare and not very visible.

The authors highlight the need to expand the FDA's authority to regulate cross-marketing of heated tobacco products with alcohol, implement platform-specific policies that restrict coordinated posting of harmful product messages, monitor social media content that encourages co-use of multiple substances, and develop educational campaigns that specifically address cultural narratives that normalize dual use.

In general, the tobacco and nicotine industry tends to segment its customers with differentiated marketing strategies and products. Another example is the tobacco and nicotine industry's exploitation of other identities, like the LGBTQ+ community. This support also comes through social media and is intended to be opportunistic: thus, Japan Tobacco International (JTI), the primary private financier of Trump's 2024 campaign, has stopped all publications on X related to inclusivity since his re-election; Philip Morris France publishes a lot during Pride Month; British American Tobacco (BAT), through its nicotine pouch brand VELO, has set up communication campaigns based on figures from the queer and drag scene... All these strategies aim to create in the same way an artificial correlation between nicotine products and social groups, in order to build long-term customer loyalty.

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[1]Kim Y., Kresovich A., Page S. et al, “Copromotion across commercial determinants of health: content analysis of smokeless tobacco social media messages referencing alcohol, 2016–2021”, Tobacco Control, published August 21, 2025, accessed August 25, 2025, 10.1136/tc-2025-059523

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