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Background  Substance use by youth remains a significant public health concern. Social media provides the opportunity to discuss and display substance use–related beliefs and behaviors, suggesting that the act of posting drug-related content, or viewing posted content, may influence substance use in youth. This aligns with empirically supported theories, which posit that behavior is influenced by perceptions of normative behavior. Nevertheless, few studies have explored the content of posts by youth related to substance use.    Objective  This study aimed to identify the beliefs and behaviors of youth related to substance use by characterizing the content of youths’ drug-related tweets. Using a sequential explanatory mixed methods approach, we sampled drug-relevant tweets and qualitatively examined their content.    Methods  We used natural language processing to determine the frequency of drug-related words in public tweets (from 2011 to 2015) among youth Twitter users geolocated to Pennsylvania. We limited our sample by age (13-24 years), yielding approximately 23 million tweets from 20,112 users. We developed a list of drug-related keywords and phrases and selected a random sample of tweets with the most commonly used keywords to identify themes (n=249).    Results  We identified two broad classes of emergent themes: functional themes and relational themes.  Functional  themes included posts that explicated a function of drugs in one’s life, with subthemes indicative of  pride ,  longing ,  coping , and  reminiscing  as they relate to drug use and effects.  Relational  themes emphasized a relational nature of substance use, capturing substance use as a part of social relationships, with subthemes indicative of drug-related  identity  and  companionship . We also identified topical areas in tweets related to drug use, including reference to  polysubstance use ,  pop culture , and  antidrug  content. Across the tweets, the themes of  pride  (63/249, 25.3%) and  longing  (39/249, 15.7%) were the most popular. Most tweets that expressed  pride  (46/63, 73%) were explicitly related to marijuana. Nearly half of the tweets on  coping  (17/36, 47%) were related to prescription drugs. Very few of the tweets contained  antidrug  content (9/249, 3.6%).    Conclusions  Data integration indicates that drugs are typically discussed in a positive manner, with content largely reflective of functional and relational patterns of use. The dissemination of this information, coupled with the relative absence of antidrug content, may influence youth such that they perceive drug use as normative and justified. Strategies to address the underlying causes of drug use (eg, coping with stressors) and engage antidrug messaging on social media may reduce normative perceptions and associated behaviors among youth. The findings of this study warrant research to further examine the effects of this content on beliefs and behaviors and to identify ways to leverage social media to decrease substance use in this population.

Exploring Substance Use Tweets of Youth in the United States: Mixed Methods Study