Background: Understanding how social media platforms facilitate information exchange and influence behavior during health crises can enhance public health response during times of uncertainty. This study aimed to characterize and contextualize e-cigarette-related behavior changes during the early COVID-19 pandemic and illuminate the role that social media played in decision making. 

Methods: We conducted a qualitative analysis of COVID-19-related e-cigarette discussions on three anonymous Reddit forums about e-cigarettes. Posts were collected from June 27 to July 3, 2020 (discussion threads=189; comments=3,155). We developed and applied emergent codes, identified thematic patterns across codes, and developed a model to synthesize the social-ecological context of e-cigarette behaviors.  

Results: E-cigarette subreddits provided a platform for Redditors with similar experiences, ideas, and perspectives on the world to have rich conversations. Redditors drew from their existing perceptions, intentions, and experiences with e-cigarettes; their personal pandemic experience; and their participation on Reddit to decide about whether and how to change their e-cigarette behaviors. Consumption of media (e.g., news articles, peer-reviewed publications), associated commentary shared on Reddit played a role in shaping behavior. Decisions were complicated by distrust of the media. 

Conclusion: Information (and misinformation) from Reddit informed risk perceptions and decisions during the pandemic that might have increased risk. Moving forward, messaging should consider the stress, struggles, and stigma surrounding e-cigarette users and address the roles mistrust and misinformation play in decisions.