Introduction: On January 2, 2020, the FDA announced a policy focused in part on prioritizing enforcement of flavored (other than tobacco- or menthol-flavored) cartridge-based electronic nicotine delivery systems (ENDS) without premarket authorization.
Methods: We used a query to identify Reddit conversations relevant to the policy from January 2 to May 6, 2020. Our sample included 576 posts (46 posts and 530 accompanying comments). Two analysts coded posts for mentions of use behaviors (e.g., switching, quitting), purchasing behaviors (e.g., purchasing from retailer new to the user), and flavored products. We summarized frequencies of coded data and provided illustrative quotes.
Results: Only 21.0% (121/576) of posts mentioned use behavior. Switching behavior was the most common use behavior mentioned (50.4%, 61/121). Most switching behavior posts focused on ENDS-related switching (91.8%, 56/61). The most common ENDS-related switching behaviors mentioned were switching to an open tank (45.9%, 28/61) or device with refillable pods/cartridges (44.3%, 27/61); 8.2% (5/61) mentioned switching to disposables. Just 15.5% (89/576) of posts mentioned purchasing behavior, with the most common being purchasing from a retailer new to the user (32.6%, 29/89). Only 6.8% (39/576) of posts mentioned specific flavors.
Conclusion: Reddit posts about the policy commonly discussed switching to non-cartridge-based ENDS products, such as open tank systems or disposable devices, and purchasing products from different online sources that were still selling these products. Findings suggest that publicly available Reddit data can complement data from traditional sources (e.g., surveys, sales) to understand potential unintended consequences associated with policies by exploring the public's reactions.
This essay explores lessons learned when conducting focus group interviews with participants exposed to novel health-risk messages. Focus group participants exposed to new health-risk information might be defensive, affecting the quality of the data collected. Hence, accounting for potential participant defensiveness is of great importance for researchers who are developing and testing these health-risk messages. In this essay, I identify two forms of defensiveness that emerged in my focus group study evaluating cancer warning labels on alcoholic beverages: (1) actively counterarguing the health-risk message and (2) repeatedly modifying the health-risk message. I also offer four "lessons learned" to improve health-risk message testing in qualitative research practice: (a) communicate with empathy, (b) use personal stories, (c) forewarn participants, and (d) offer a self-affirmation opportunity. Overall, this essay contributes to the development of a typology of defensive strategies that focus group participants may use when exposed to novel health-risk messages. Additionally, it provides a methodological framework for guarding the integrity of the data and climate of the focus groups. These insights are valuable for health communication researchers and practitioners interested in conducting focus groups to assess health-risk messages.

