AbstractThe mass media play a crucial role in informing the masses about various health issues, they are the main source of health information. The media's portrayal of electronic cigarette news, therefore, plays a crucial role in shaping audience attitudes and understanding of electronic cigarettes. This narrative review focused on content analytical studies on electronic cigarettes in different countries and regions as published in various peer-reviewed journals and available on Google Scholar. In the instances where electronic cigarette consumption is presented with negative frames, the accompanying overall story topics are mostly related to policy issues and the most commonly used news sources are government officials and legislators. It was also observed that news framing in other countries is somewhat balanced. This could be attributed to mounting scientific findings about the health impact of e-cigarettes. Therefore, a causal direction would likely follow where health officials and scientist would be the main and most frequently used sources of information.Keywords: Portrayals, electronic cigarettes, vaping, news media, content analysis, frame building.BackgroundElectronic cigarette use has become an international phenomenon in recent years (Gravely et al., 2018, p. 86), with many countries reporting an increase in the number of electronic cigarette users. In research from Jerzyński et al. (2021, p. 6), the estimated number of electronic cigarette users in 2018 was 58.1 million worldwide. Rooke and Amos (2013, p. 1) state that electronic cigarettes have recently been attracting interest for their potential as a less harmful alternative to smoking, their rising popularity, and the regulatory issues they raise. Due to the increased popularity of electronic cigarettes, media coverage of the topic has also increased (Kim et al., 2017, p. 443). Mass media provides the main source of health information, in that "approximately 80% of the public rely on general media for information about health topics, greater than the percentage of those who rely on physicians" (Chang, 2011, p. 117). This means that the media plays a crucial role in informing the masses on various health issues. On the other hand, Larson (2018, p. 309) argues that disseminating conflicting information, and manipulated information in the media should be viewed as a threat to public health. Godshall (2015, p. 9) believes that biased media coverage of electronic cigarettes is one of the contributing factors leading to the formulation of unfavorable policies in some countries. For instance, in Africa, the sale of electronic cigarettes is banned in Uganda, Gambia, Mauritius, and Ethiopia. However, little effort has been done to understand the media framing of electronic cigarettes in African countries.It is therefore important to conduct an analysis of news portrayals, particularly at this early stage of public adoption and use, as news media play an important role in shaping public perceptions and may inform the direction of future government policies on electronic cigarettes Kim et al. (2017, p. 444). As suggested by Hivon et al. (2009, p. 44), it is also important that media provide their audiences with comprehensive and accurate information on issues related to health, science, and technology. MethodsThe review focused on the types of frames that dominate coverage of electronic cigarette use and health in general. It also examined how balanced the reporting is and finally examined the potential impact of reporting on public perceptions. The narrative review included relevant articles published through 2022. The data sources included journal articles on Google Scholar and the search terms used include portrayals, electronic cigarettes, vaping, news media, content analysis, and frame building.The inclusion criteria include published papers that provide information regarding news framing of electronic cigarettes in various countries and regions and the exclusion criterion was all other data sources that do not provide information regarding the framing of electronic cigarettes.Results and discussion The literature review notes that several studies examining how the media presents e-cigarettes in their reporting have been done in various countries and regions of the world. However, no study to my knowledge has been done to establish the trends anywhere in Africa. Besides, little has been done to understand the underlying reasons why media presents electronic cigarettes in certain ways. Frames and tones that dominate news coverageKim et al. (2017) in their study on news media presentations of electronic cigarettes in South Korea reveal that news coverage and framing of electronic cigarettes concentrated more on drawbacks than on the potential positive health outcomes. Similarly, Lyu et al. (2021) examined longitudinal changes in media frames and media tones about e-cigarettes in Chinese newspapers and it was found that the tone of the large majority of news articles was unfavorable towards electronic cigarettes. Additionally, East et al. (2022) found that between 2017 and 2020, youth exposure to negative news stories, and perceptions of vaping harms, increased in England, Canada, and the United States of America.Negative framing by the media may mean both a public panic and an immediate response from the government whether leaders are prepared to respond at the time or not. Such a scenario would force authorities to formulate policies basing on a fallacy that appeal to emotions instead of basing on science and evidence. Consequently, such policies could end up doing more harm to public health than good. On the other hand, content analysis studies from (Lyu et al., 2021) and (Kim et al, 2017) reveal that media coverage framed electronic cigarette use more as a policy than a health issue. Kim et al. (2017) suggest that the issue was framed as a policy issue because the primary news sources on electronic cigarettes were mostly government officials and lawmakers, entailing that journalistic practices on choices of news sources by news writers could have an impact on how news is framed.Kang et al. (2021b) also analyzed how arguments regarding e-cigarettes are presented in the print news media in the United States of America (USA), the United Kingdom (UK), and Korea. The study found that the most salient argument in the USA and UK was that e-cigarettes are less harmful than combustible cigarettes. Although both USA and UK news recognized electronic cigarettes as a smoking cessation tool, USA news framed electronic cigarettes from a negative viewpoint. Whilst in Korean news, the dominant argument concerned electronic cigarette ingredients.Inconsistencies in dominant frames across the three countries could be attributed to regional differences which may include differences in priorities and investment in scientific research on the health impacts of electronic cigarette use. For example, in contrast to USA and Korea, several reputable public health agencies in the UK such as Public Health England have conducted independent and landmark research concluding that electronic cigarettes are a safer means of consuming nicotine as compared to combustible cigarettes (Public Health England, 2015). Impartiality in reportingKim et al. (2017) found that government officials and lawmakers were either cited or referenced most often than doctors, scientists, average citizens, and others. Some scholars suggest that journalists oftentimes provide a partial picture by only capturing the point of view of government officials and lawmakers, overlooking the points of view of health experts and vulnerable concerned participants (Hivon et al., 2009). In this case, the sidelined views of vulnerable stakeholders are the views of electronic cigarette users, meaning that they are given less chance to explain the health benefits and negative consequences they experience firsthand through electronic cigarettes.Schudson (1989) concludes that news representation is selective and news writers color the news to advance a political, economic, or ideological aim. This implies that people's perception of electronic cigarettes is shaped by the perspectives of the social-political elite and not the voice of the consumer who has firsthand information about electronic cigarette use.The impact of coverage on people's perceptionsThe study by Chang (2011) on news coverage on health-related issues found that health news, in general, is more likely to use alarm than coping frames. For example, in a related content analysis on Ebola by Wallis & Nerlich (2005), the study found that health issues like diseases are depicted as killers, plagues, or hostile combatants in war. Such frames are more likely to cause fear and vulnerability to the general public as supported by the all-powerful media effects theory which suggests that audiences passively accept media messages and show predictable responses in response to the messages (Shaw, 1979).Chang (2011) further states that newsworthiness determines what gets covered, and threats are highly likely to gain media attention. News writers and media houses could deliberately be using such frames on the topic to gain public attention and maximize profit (McManus, 1992). In so doing, they forego the journalistic norm of objectivity. Such behavior of the media is also well explained by Chong (2017, p. 5), he argues that objectivity is embedded in organizational constraints, making the norm ambiguous, contextual, and unattainable.However, Chang (2011) suggests that frames that are most likely to promote public health effects are probably mixed frame that features both high alarm information and high coping information.ConclusionThe narrative review reveals how the media in different regions and countries frame stories about electronic cigarette use and speculates the possible implications of framing on the audience's perceptions but little is done to understand the underlying reasons for news framing in a certain way. In the instance where electronic cigarette use is framed as a policy issue, the key and commonly used sources are mostly government officials and legislators. It can thus be speculated that a story framed as a health issue is likely to have doctors, researchers, and public health institutions as primary and commonly used sources. This entails that journalistic practices could have an implication on news framing and in turn influence the perception of the audiences.AcknowledgmentsThe author received no funding to develop this paper.Conflict of interest The author declares no competing interests.Ethics statementThis narrative review is part of the main study titled "portrayals of electronic cigarette use; a content analysis of news coverage by online news sites in Africa" which received ethics clearance through the National Health Sciences and Research Committee in Malawi (protocol # 22/08/2953).Author contributionsThis paper was conceptualized and developed by Chimwemwe Ngoma. 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