Longitudinal associations between U.S. youth exposure to E-cigarette marketing and E-cigarette use harm perception and behavior change

Exposure to nicotine pouch marketing and nicotine pouch experimentation among U.S. adults who use commercial tobacco

Objective

U.S. nicotine pouch (NP) sales have grown since 2016. Among U.S. adults who currently and formerly used commercial tobacco, we examined demographic associations with learning about NPs through varying marketing channels, and their associations with NP experimentation overall and stratified by race/ethnicity.

Methods

A nationally representative sample of U.S. adults who currently and formerly used commercial tobacco (n = 1,700) were surveyed online in January-February 2021. Participants reported their demographics and whether they learned about NPs through nine marketing channels. We used weighted multivariable logistic regressions to examine demographic associations of each channel, and each channel's association with NP ever-use.

Results

Overall, 45.2 % were aware of NPs, and 17.4 % ever used NPs. Highest reported NP awareness was through stores (16.6 %), internet/social media ads (9.2 %), friends/family's social media (8.2 %), direct mail/email (7.6 %), and print media ads (6.9 %). Younger, female, Black and Hispanic (vs. White) adults had lower odds of NP awareness through various marketing channels than their counterparts. Black adults (vs. White) had higher odds of NP awareness through news stories on TV/radio/online. Awareness through each channel was associated with higher odds of ever-using NPs, especially brand sponsored events, brand website/social media accounts, and direct mail/email (p's < 0.05). Results were generally consistent when stratified by race/ethnicity, but notable differences were also observed (race/ethnicity interaction p < 0.05).

Conclusions

NP marketing may promote NP experimentation among U.S. adults who use commercial tobacco. Future research should examine whether exposure to NP marketing leads to poly-tobacco use, which could increase the detrimental health effects of tobacco use.

Exposure to user-generated e-cigarette content on social media associated with greater vulnerability to e-cigarette use among youth non-users

INTRODUCTION

Social media are important venues for youth's exposure to e-cigarette content. This study examined how exposure to user-generated e-cigarette content (i.e., content created and shared by individual social media users) is associated with vulnerabilities to e-cigarette use among youth non-users.

METHODS

We pooled data from the 2021 and 2022 National Youth Tobacco Survey. Youth who have never used e-cigarettes were included. Weighted linear and logistic regressions were conducted to examine how exposure to user-generated e-cigarette content (from real-life friends, online-only friends, and celebrities/influencers) on social media was associated with e-cigarette use vulnerabilities measured by perceived norms, perceived risk, and susceptibility of use, controlling for demographics, advertising exposure, and mental health conditions. Multiple imputations were performed to account for missing data.

RESULTS

Exposure to e-cigarette content on social media posted by real-life friends, online-only friends, and celebrities/influencers were associated with more positive descriptive norm (βs = 1.56, 0.37, and 0.35, respectively, all ps < .001), more positive injunctive norm (βs = 0.46, 0.19, and 0.10, respectively, all ps < .001), and higher odds of e-cigarette use susceptibility (ORs = 1.48, 1.50. 1.29, respectively, all ps < .001). Exposure to content posted by real-life and online-only friends were associated with reduced risk perception of e-cigarette use (β = -0.04, p < 0.05 and β = -0.07, p < 0.001).

CONCLUSIONS

Our study highlighted that friends and celebrities/influencers are important sources on social media that can influence youth non-users' vulnerabilities to e-cigarette use. Interventional messages communicated through friends and influencers on social media may in turn help reduce e-cigarette vulnerability among youth non-users.

Youth attention, perceptions, and appeal in response to e-cigarette advertising features: A focus group study

Background

E-cigarette marketing exposure may influence vaping-related outcomes among youth, but less is known on which specific advertising features impact youth attention, perceptions, and appeal. This study qualitatively examines responses to different e-cigarette advertising features among e-cigarette-naïve youth.

Methods

We conducted four online focus groups in 2021 with a national U.S. sample of 13-17 year olds (n = 25) who had never used e-cigarettes. Participants viewed and discussed their reactions to different e-cigarette advertisements varying in the inclusion of ad features, including color, models in imagery, text claims targeting smokers, and the nicotine warning label.

Results

Participants were attracted to ads with bright colors, particularly when contrasted against a dark background. Ads featuring models attracted attention and reduced perceptions that the product is harmful. Comments indicated mixed reactions to smoker-targeted text claims. On one hand, participants perceived ads with text that specified "for smokers" as targeting older adults. On the other hand, text referring to "switching" from cigarettes to e-cigarettes led to some perceptions that the product is healthy, and certain text that implicitly referred to smoking (e.g., "no odor") had the potential to appeal to youth who wanted to use e-cigarettes discreetly. The level of attention paid to warnings depended on warning size and the color contrast between the warning and the rest of the ad.

Conclusions

Findings suggest specific e-cigarette ad features play an important role in attracting youth attention and influencing perceptions. More research is needed on the potential public health benefits versus unintended consequences of smoker-targeted text claims.

Current perspective on e-cigarette use and respiratory outcomes: mechanisms and messaging

INTRODUCTION

There has been an increasing amount of research on the consequences of e-cigarette use for respiratory outcomes, which is significant for public health and respiratory medicine. We discuss recent findings and lay out implications for prevention and treatment.

AREAS COVERED

Based on literature searches using several databases (PubMed, Web of Science, Google Scholar) for keywords, including synonyms, 'e-cigarettes,' with 'pulmonary function,' 'oxidative stress,' and 'inflammation,' we review studies on acute effects of e-cigarette use for measures of pulmonary function and discuss selected laboratory studies on mechanisms of effect, focusing on processes with known relation to respiratory disease; oxidative stress and inflammation. We discuss available studies that have tested the effectiveness of communication strategies for prevention of e-cigarette use oriented to different audiences, including nonsmoking adolescents and adult smokers.

EXPERT OPINION

We conclude that the evidence presents a mixed picture. Evidence is found for adverse consequences of e-cigarette use on measures of lung function and two disease-related biological processes, sometimes but not always less than for cigarette smoking. How to best communicate these results to a complex audience of users, from younger susceptible adolescents to long-term adult smokers interested in quitting, is a question of significant interest and empirically validated communication strategies are greatly needed.

Associations Between Noticing E-Cigarette Advertising Features and E-Cigarette Appeal and Switching Interest Among Young Adult Dual Users

BACKGROUND

E-cigarette advertising, which often includes various features, may prompt e-cigarette use and product switching. This study examined the associations between noticing e-cigarette ad features and perceived product appeal and interest in completely switching from cigarettes to advertised e-cigarettes among young adult dual users of both products.

METHODS

We analyzed data from an online heatmap experiment among young adult dual users defined as established cigarette smokers who currently used e-cigarettes (ages 18-34 years; n = 1,821). Participants viewed 12 e-cigarette ads, clicked on ad features (e.g., fruit flavors, nicotine warnings, price promotions, smoker-targeted claims) that attracted their attention (defined as "noticing"), and answered questions about e-cigarette product appeal and interest in completely switching from cigarettes to the e-cigarettes shown. We examined within-person associations between noticing specific ad features and outcomes, controlling for demographic and tobacco use-related characteristics.

RESULTS

Noticing fruit flavors (AOR = 1.67 and 1.28) and fruit images (AOR = 1.53 and 1.21) was positively associated with having any e-cigarette product appeal and switching interest. Noticing price promotions (AOR = 1.23) was positively associated with product appeal. In contrast, noticing nicotine warnings (AOR = 0.74 and 0.86), smoker-targeted claims (AOR = 0.78 and 0.89), and tobacco flavors (AOR = 0.92 and 0.90) was negatively associated with product appeal and switching interest.

CONCLUSIONS

Noticing certain e-cigarette ad features (e.g., fruit flavors and nicotine warnings) may be associated with product appeal and/or switching interest among young adult dual users. More research is needed to assess the influence of e-cigarette ad features that promote product switching interests among cigarette smokers while discourage interests among tobacco-naïve individuals.

Young adults' visual attention to features of social media marketing for disposable e-cigarettes and associated perceptions

BACKGROUND AND AIMS

E-cigarette marketing exposure on social media influences perceptions; however, limited knowledge exists regarding marketing features attracting the most visual attention. This study examined visual attention to features of social media marketing for disposable e-cigarettes and related product perceptions.

DESIGN, SETTING AND PARTICIPANTS

Participants viewed 32 disposable marketing post images from social media (Instagram) using computer-based eye-tracking technology to assess standardized attention metrics of marketing features. They then completed a survey assessing positive product perceptions. The study took place in New Jersey, USA, June-September 2022, comprising young adults (aged 18-29) who do not use tobacco (n = 72) or who smoke cigarettes (n = 42).

MEASUREMENTS

We examined associations between 14 marketing features (e.g. product package, personal item, fruit/candy descriptor, social media account) and standardized attention metrics of dwell time (fixation duration) and entry time (time to first fixation). Then, we assessed attention metrics for each feature in relation to positive product perceptions (appeal and positive use expectancy).

FINDINGS

Among all participants, dwell time was the longest for the product descriptor [marginal means (MM) = 1.77; 95% confidence interval (CI) = 1.69, 1.86], social media account (MM = 1.76; 95% CI = 1.67, 1.85) and fruit/candy descriptor features (MM = 1.56; 95% CI = 1.41, 1.70); entry time was the shortest for the social media account (MM = 0.35; 95% CI = 0.26, 0.46), personal item (MM = 0.36; 95% CI = 0.17, 0.56) and human model features (MM = 0.40; 95% CI = 0.08, 0.72). Two use status groups had comparable dwell and entry times, except for the product descriptor feature. Longer dwell time for the product package feature increased positive product perceptions among both use status groups [regression coefficient (β) = 0.44 and 2.61]. Longer dwell time for fruit/candy descriptor (β = 1.80) and price promotion features (β = 4.04) increased positive product perceptions among those who smoke.

CONCLUSIONS

US young adults appear to be particularly visually engaged by disposable e-cigarette marketing that uses social media account features (account profile pictures, information about the products marketed and relevant hashtags) and features enhancing the products' personal relatability. Disposable product packages, fruit/candy descriptors and price promotions may increase the influence of social media marketing among various use status groups.

Association of time spent on social media with youth cigarette smoking and e-cigarette use in the UK: a national longitudinal study

BACKGROUND

Social media may influence children and young people's health behaviour, including cigarette and e-cigarette use.

METHODS

We analysed data from participants aged 10-25 years in the UK Household Longitudinal Study 2015-2021. The amount of social media use reported on a normal weekday was related to current cigarette smoking and e-cigarette use. Generalised estimating equation (GEE) logistic regression models investigated associations of social media use with cigarette smoking and e-cigarette use. Models controlled for possible confounders including age, sex, country of UK, ethnicity, household income and use of cigarette/e-cigarettes by others within the home.

RESULTS

Among 10 808 participants with 27 962 observations, current cigarette smoking was reported by 8.6% of participants for at least one time point, and current e-cigarette use by 2.5% of participants. In adjusted GEE models, more frequent use of social media was associated with greater odds of current cigarette smoking. This was particularly apparent at higher levels of use (eg, adjusted odds ratio (AOR) 3.60, 95% CI 2.61 to 4.96 for ≥7 hours/day vs none). Associations were similar for e-cigarettes (AOR 2.73, 95% CI 1.40 to 5.29 for ≥7 hours/day social media use vs none). There was evidence of dose-response in associations between time spent on social media and both cigarette and e-cigarette use (both p<0.001). Analyses stratified by sex and household income found similar associations for cigarettes; however, for e-cigarettes associations were concentrated among males and those from higher household income groups.

CONCLUSIONS

Social media use is associated with increased risk of cigarette smoking and e-cigarette use. There is a need for greater research on this issue as well as potential policy responses.

Impact of product-based e-cigarette marketing on the attitudes and behavioural intentions of young Australians: an experimental study

BACKGROUND

The tobacco industry has a history of using language to downplay the harms associated with cigarettes and mislead consumers and policymakers. Emerging evidence suggests similar tactics are being used in the context of e-cigarettes; however, exploration of the impact of product name on attitudes towards e-cigarettes and susceptibility to use is lacking. This experimental study explored whether attitudes towards e-cigarettes and susceptibility to use are influenced by the names used by the industry to describe and market these products.

METHOD

An accredited web panel provider recruited a sample of 383 Australians aged 12-29 years who had never smoked to participate in an online survey that featured an embedded experiment. Participants were randomly allocated to one of three conditions, each of which used a different name to describe e-cigarettes (condition 1: 'e-cigarettes', condition 2: 'vapes'; condition 3: either 'IGETS', 'Puff Bars', 'HQD Cuvies' or 'Gunnpods'). The survey assessed respondents' overall opinion of the product described; attitudes towards the product; liking of the product; and curiosity, willingness and intentions to use the product.

RESULTS

Those in the 'brand name' condition scored higher than those in the 'e-cigarettes' condition on all dependent variables. Those in the 'vapes' condition scored higher than those in the 'e-cigarettes' condition on product attitude.

CONCLUSION

Findings indicate that the use of brand names and terms such as 'vapes' instead of 'e-cigarettes' results in more favourable attitudes towards e-cigarettes and susceptibility to use among young Australians. Results highlight the problematic influence of promotional language use favoured by industry.

A four-year longitudinal analysis examining the effects of e-cigarette advertisements and disparities among youth with internalizing problems

BACKGROUND

Prior research indicates a direct, short-term effect of e-cigarette advertising on e-cigarette use among youth. This study seeks to investigate the long-term effects of e-cigarette advertisements and disparities in exposure among adolescents with different levels of internalizing problems.

METHODS

Panel data of the Population Assessment of Tobacco and Health (PATH) Study Waves 3-5 (2015-2019) were analyzed. Youth aged 12-17 who were non-e-cigarette users at the time of Wave 3 were included (n = 4,678). A moderated mediation model was employed to examine the mediating role of perceived harm of e-cigarettes and the moderating effect of internalizing problems.

RESULTS

Exposure to e-cigarette advertisements in Wave 3 predicted lower harm perception of e-cigarette in Wave 4 (bp = -0.055, p <.01), leading to more e-cigarette use in Wave 5 (bp = -0.042, p <.001). While e-cigarette advertisements exhibited a lasting indirect effect (bp = 0.002, p <.05), there was no long-term direct effect (bp = 0.017, p >.05) on youth e-cigarette use. Furthermore, a moderating effect of internalizing problems was observed (bp = 0.107, p <.05).

CONCLUSIONS

E-cigarette advertisements can exert a lasting influence indirectly by diminishing harm perception, particularly among those with lower internalizing problems. Adolescents with higher internalizing problems exhibit lower susceptibility to advertisement influence, yet their perceived harm of e-cigarettes is notably lower than their peers with fewer internalizing problems. These disparities underscore the need for tailored prevention strategies: implementing anti-e-cigarette education programs for adolescents with low internalizing problems and providing mental health care for those facing internalizing challenges. Regulatory measures targeting e-cigarette advertising are also crucial.

Using Eye tracking to Examine Young Adults' Visual Attention to E-cigarette Advertising Features and Associated Positive E-cigarette Perceptions

BACKGROUND

Little is known about the influence of e-cigarette marketing features on the antecedents of e-cigarette use.

PURPOSE

Using an eye-tracking experiment, we examined visual attention to common features in e-cigarette ads and its associations with positive e-cigarette perceptions among young adults.

METHODS

Young adults (ages 18-29) who smoke cigarettes (n = 40) or do not use tobacco (n = 71) viewed 30 e-cigarette ads on a computer screen. Eye-tracking technology measured dwell time (fixation duration) and entry time (time to first fixation) for 14 pre-defined ad features. Participants then completed a survey about perceptions of e-cigarettes shown in the ads. We used regression models to examine the associations between ad features and standardized attention metrics among all participants and by tobacco-use status and person-aggregated standardized attention for each ad feature and positive e-cigarette perceptions.

RESULTS

Dwell time was the longest for smoker-targeted claims, positive experience claims, and price promotions. Entry time was the shortest for multiple flavor descriptions, nicotine warnings, and people. Those who do not use tobacco had a longer dwell time for minor sales restrictions and longer entry time for purchasing information than those who smoke. Longer dwell time for multiple flavor descriptions was associated with e-cigarette appeal. A shorter entry time for fruit flavor description was associated with positive e-cigarette-use expectancies.

CONCLUSIONS

Young adults allocated attention differently to various e-cigarette ad features, and such viewing patterns were largely similar by tobacco-use statuses. Multiple or fruit flavors may be the features that contribute to the positive influence of e-cigarette marketing among young adults.

Racial/ethnic disparities in exposure to e-cigarette advertising among U.S. youth

OBJECTIVES

This study aims to assess exposure to e-cigarette advertising across multiple marketing channels among U.S. youth and to examine whether racial/ethnic disparities exist in exposure to e-cigarette advertisements.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Cross-sectional data were drawn from a longitudinal survey of participants recruited from two nationally representative panels (NORC's AmeriSpeak® and GfK's KnowledgePanel). A total of 2043 youth aged 13-17 completed the initial 2018 survey, and 2013 youth completed the follow-up survey in 2019 (including a replenishment sample of 690 youth). Outcome variables were self-reported e-cigarette advertisement exposure in the past three months through various sources, such as television, point of sale, and online/social media. Generalized estimating equation models were used to estimate the adjusted odds ratios (AOR) of the association between racial/ethnic identity and e-cigarette advertisement exposure.

RESULTS

The prevalence of reported exposure to e-cigarette advertisements through any channel was 79.8% (95% CI: 77.1-82.2) in 2018 and 74.9% (95% CI: 72.5-77.1) in 2019, respectively. Point of sale was the most common source of e-cigarette advertisement exposure in both years. Non-Hispanic Black and non-Hispanic Asian youth were more likely to report exposure to e-cigarette advertisements through television (AOR = 2.07, 95% CI: 1.44-2.99 and AOR = 2.11, 95% CI: 1.17-3.82, respectively) and online/social media (AOR = 1.61; 95% CI: 1.11-2.33 and AOR = 1.99, 95% CI: 1.10-3.59, respectively) channels compared with non-Hispanic White youth.

CONCLUSIONS

A substantial proportion of U.S. youth reported exposure to e-cigarette advertising through a variety of marketing channels. Significant racial/ethnic disparities existed, with non-Hispanic Black and Asian youth reporting more marketing exposure than their non-Hispanic White counterparts.

Using Computer Vision to Detect E-cigarette Content in TikTok Videos

INTRODUCTION

Previous research has identified abundant e-cigarette content on social media using primarily text-based approaches. However, frequently used social media platforms among youth, such as TikTok, contain primarily visual content, requiring the ability to detect e-cigarette-related content across large sets of videos and images. This study aims to use a computer vision technique to detect e-cigarette-related objects in TikTok videos.

AIMS AND METHODS

We searched 13 hashtags related to vaping on TikTok (eg, #vape) in November 2022 and obtained 826 still images extracted from a random selection of 254 posts. We annotated images for the presence of vaping devices, hands, and/or vapor clouds. We developed a YOLOv7-based computer vision model to detect these objects using 85% of extracted images (N = 705) for training and 15% (N = 121) for testing.

RESULTS

Our model's recall value was 0.77 for all three classes: vape devices, hands, and vapor. Our model correctly classified vape devices 92.9% of the time, with an average F1 score of 0.81.

CONCLUSIONS

The findings highlight the importance of having accurate and efficient methods to identify e-cigarette content on popular video-based social media platforms like TikTok. Our findings indicate that automated computer vision methods can successfully detect a range of e-cigarette-related content, including devices and vapor clouds, across images from TikTok posts. These approaches can be used to guide research and regulatory efforts.

IMPLICATIONS

Object detection, a computer vision machine learning model, can accurately and efficiently identify e-cigarette content on a primarily visual-based social media platform by identifying the presence of vaping devices and evidence of e-cigarette use (eg, hands and vapor clouds). The methods used in this study can inform computational surveillance systems for detecting e-cigarette content on video- and image-based social media platforms to inform and enforce regulations of e-cigarette content on social media.

Associations between e-cigarette marketing exposure and vaping nicotine and cannabis among U.S. adults, 2021

Importance

Vaping has become an increasingly common method for consuming nicotine and cannabis, a trend potentially influenced by e-cigarette marketing. However, little is known about the influence of e-cigarette marketing on cannabis vaping behaviors.

Objective

To examine the associations between e-cigarette marketing exposure and nicotine and cannabis vaping behaviors among adults.

Design Setting and Participants

This cross-sectional study included a U.S. nationally representative sample of adults (≥18 years) from the Wave 6 survey of the Population Assessment of Tobacco and Health (PATH) Study, conducted from March to November 2021.

Exposure

Past 30-day e-cigarette marketing exposure (overall and by ten marketing channels).

Main Outcomes and Measures

Past 30-day vaping behavior (sole- and dual-vaping of nicotine and cannabis) overall and stratified by age.

Results

The study included 30,516 respondents (48.0% male and 63.9% non-Hispanic White). Overall, 52.0% of respondents reported past 30-day e-cigarette marketing exposure, and 89.8%, 5.6%, 3.2%, and 1.4% reported no vaping, sole-nicotine vaping, sole-cannabis vaping, and dual-vaping, respectively. Multinominal logistic regression results show exposure to e-cigarette marketing was associated with increased odds of reporting sole-cannabis vaping versus no vaping (adjusted risk ratio [aRR], 1.31; 95% confidence interval [CI], 1.09-1.57) and dual-vaping versus no vaping (aRR, 1.26; 95% CI, 1.01-1.57). Stratification analysis found these associations among those aged 18-24 and 25-34 years but not older adults (≥35 years). Those exposed to e-cigarette marketing also had increased odds of reporting sole-cannabis vaping versus sole-nicotine vaping (aRR, 1.28; 95% CI, 1.04-1.58). Stratification analysis found this association only among those aged 18-24 years. E-cigarette marketing exposure via several channels (retail stores, billboards, events, newspapers/magazines) was associated with increased odds of reporting sole-cannabis vaping.

Conclusions and Relevance

E-cigarette marketing exposure was only associated with sole-cannabis vaping and dual-vaping, not sole-nicotine vaping among U.S. adults. Such associations were mainly driven by young adults aged 18-24 and 25-35 years and were found for multiple marketing channels. Greater restrictions on tobacco marketing may have reduced the influence of e-cigarette marketing on nicotine vaping, while gaps in such marketing restrictions for cannabis may contribute to continued influence of e-cigarette marketing on cannabis vaping.

Immigration status-related exclusive e-cigarette use and cannabis use and their dual use disparities associated with mental health disorder symptoms

INTRODUCTION

E-cigarette and cannabis use has been linked to various health risks, including respiratory and cardiovascular conditions. Yet, extant knowledge about the risk factors for exclusive and dual use of e-cigarettes and cannabis is limited, especially among immigrants. We examined exclusive e-cigarette and cannabis use and their dual use associated with mental health disorders among immigrants and U.S.-born.

METHODS

We analyzed national cross-sectional data collected between May 13, 2021, and January 9, 2022, among adults aged >18 years (n= 4766) living in U.S. Multinomial logistic regression analyses were conducted to model the associations of exclusivity and dual-use (reference group= non-use) with anxiety/depression.

RESULTS

The dual-use prevalence was higher than exclusive e-cigarette and cannabis use, especially among U.S.-born (dual use= 14.79% vs. cannabis use= 13.53% vs. e-cigarette use= 7.11%) compared to immigrants (dual use= 8.23% vs. cannabis use= 5.03% vs. e-cigarette use= 6.31%). Immigrants had lower risks of exclusive cannabis and dual use compared to U.S.-born. Anxiety/depression was associated with higher risks of exclusive cannabis use and dual use across immigration status, but was associated with exclusive e-cigarette use among only immigrants. While effect sizes of dual-use associated with anxiety/depression were higher among U.S.-born, the effect sizes of exclusive e-cigarette and cannabis use associated with anxiety/depression were higher among immigrants.

CONCLUSIONS

The findings revealed significant mental health risks for e-cigarette, cannabis, and their dual use among immigrants and U.S.-born, especially among U.S.-born. These findings highlight the need for public health research and interventions to consider immigration status-related disparities in substance use.

How does health communication on social media influence e-cigarette perception and use? A trend analysis from 2017 to 2020

OBJECTIVE

E-cigarettes have achieved a high prevalence rapidly. While social media is among the most influential platforms for health communication, its impact on attitudes and behaviors of e-cigarettes and its changes over time remain underexplored. This study aims to address the gap.

METHODS

Four years of data (2017-2020) were derived from the U.S. Health Information National Trends Survey (HINTS) (aged 18-64 years, n = 9,914). Initially, key variables were compared across years. Furthermore, guided by the health belief model, we employed a moderated mediation model to examine the influence of social media health communication on the public's perceptions and behaviors related to e-cigarettes, distinguishing between smokers and non-smokers throughout the four-year period.

RESULTS

The evidence shows a process of dynamic interaction between communication, perception, and behavior. (1) We observed an increasing trend of social media health communication (SMH) and perceived relative harm of e-cigarettes (PHE). (2) Higher SMH was associated with more e-cigarette use directly in 2019. (3) Higher SMH was associated with less e-cigarette use indirectly through PHE in 2020. (4) Smokers consistently displayed heightened sensitivity in responding to harm perception compared to non-smokers.

CONCLUSIONS

The findings support two mechanisms underlying the association between SMH and e-cigarette use: direct and indirect. The changes in the pathways during the timespan may have been influenced by increased e-cigarette information on social media and public health events like COVID-19. Stricter regulations for unverified e-cigarette advertisements and anti-e-cigarette education on social media are called for to curtail e-cigarette use.

Viral Vaping: A systematic review and meta analysis of e-cigarette and Tobacco-Related social media content and its influence on youth behaviours and attitudes

AIMS

E-cigarette and tobacco-related content on social media continues to rise from lax restrictions on both personal and promotional posts. This content has been linked to various mechanisms of increased e-cigarette and tobacco use (i.e., lower risk perceptions and increased susceptibility). This study aimed to synthesis the association between exposure to e-cigarette and tobacco-related content and youth behaviours and attitudes.

METHODS

A comprehensive search was conducted on PubMed, Scopus, PsycINFO and Web of Science. Studies published post-2004 reporting effect estimates for exposure or engagement with e-cigarette or tobacco content on social media and behaviour or attitude outcomes were included.

RESULTS

Thirty-two studies (N = 274,283, aged 9 to 25 years) were included for synthesis. Meta-analyses revealed significant associations between engagement with tobacco content and use (OR 2.21; 95% CI = 1.27-3.82, p =.005; I2 = 96.4%), exposure to tobacco content and never users' lower risk perceptions (OR 0.68; 95% CI = 0.49-0.91; p =.011; I2 = 78.2%), and exposure to e-cigarette content and use (OR 1.37; 95% CI = 0.99-1.88; p = 0.058; I2 = 64.4%). There was no observed relationship between exposure to tobacco content and ever users' risk perceptions (OR 0.83; 95% CI = 0.61-1.13; p =.231; I2 = 83.5%). Qualitative synthesis found significant associations between tobacco exposure and increased current use and pro-tobacco attitudes; e-cigarette exposure and increased susceptibility and lower risk perceptions; tobacco engagement and increased susceptibility; e-cigarette engagement and increased use; dual exposure and increased susceptibility; and dual engagement and increased dual use. Mixed findings were identified for the influence of e-cigarette exposure on attitudes, tobacco exposure on susceptibility, dual exposure on dual use behaviours, and dual engagement on dual susceptibility.

CONCLUSIONS

Findings suggest an association between exposure and engagement to e-cigarette or tobacco products on social media and use or pro-use attitudes among youth. Further substantive research in the area of youth-specific use and attitudes following exposure and engagement with e-cigarette and tobacco content is needed to quantify this association.

Absolute and relative e-cigarette harm perceptions among young adult lesbian and bisexual women and nonbinary people assigned female at birth

PURPOSE

Young adult lesbian and bisexual women report considerable e-cigarette disparities, which may be attributed to low harm perceptions. No studies have assessed differences in e-cigarette harm perceptions in this group, nor which factors might be intervention targets to influence harm perceptions.

MATERIALS AND METHODS

We investigated differences in and modifiable correlates of e-cigarette harm perceptions among young adult lesbian and bisexual women and non-binary people assigned female at birth. Young adult women and non-binary people assigned female at birth, aged 18-30 years old, and who self-identified as lesbian or bisexual (N = 471) reported absolute and relative harm perceptions of e-cigarettes to health in an online survey. We modeled associations between harm perceptions and individual, interpersonal, and contextual factors.

RESULTS

Bisexual (vs. lesbian) participants perceived higher absolute harm of e-cigarettes (Mean (M) = 7.61 vs M = 7.09, p = .03). Participants rated e-cigarettes as slightly less harmful than cigarettes, and there was no statistically significant difference by sexual orientation (Bisexual: M = 4.84 vs Lesbian: M = 4.36). In multivariable models, bisexual (vs. lesbian) participants and Hispanic/Latinx and Other race (vs. non-Hispanic White) participants reported higher absolute and relative e-cigarette harm perceptions. Greater sexual identify affirmation and greater perceived stress were associated with higher absolute and relative e-cigarette harm perceptions.

CONCLUSIONS

E-cigarette harm perceptions vary vis-à-vis individual-level factors. Self-identification as bisexual or minoritized race/ethnicity, greater sexual identity affirmation, and greater perceived stress was associated with increased harm perceptions. Understanding variations may inform targeted health communications to reduce e-cigarette use disparities.

Marketing claims on the websites of leading e-cigarette brands in England

INTRODUCTION

Exposure to electronic cigarette (EC) marketing is associated with EC use, particularly among youth. In England, the Tobacco and Related Products Regulations and Committee of Advertising Practice (CAP) regulate EC marketing to reduce appeal to youth; however, there are little published data on EC marketing claims used online. This study therefore provides an overview of marketing claims present on the websites of EC brands popular in England.

METHODS

From January to February 2022, a content analysis of 10 of England's most popular EC brand websites was conducted, including violation of CAP codes.

RESULTS

Of the 10 websites, all presented ECs as an alternative to smoking, 8 as a smoking cessation aid and 6 as less harmful than smoking. Four websites presented ECs as risk-free. All mentioned product quality, modernity, convenience, sensory experiences and vendor promotions. Nine featured claims about flavours, colours, customisability and nicotine salts. Seven featured claims concerning social benefits, personal identity, sustainability, secondhand smoke and nicotine strength. Six featured claims about fire safety. Some claimed ECs are cheaper than tobacco (n=5), cited health professionals (n=4) or featured collaborations with brands/icons (n=4). All were assessed by the research team to violate one or more CAP code(s) by featuring medicinal claims (n=8), contents which may appeal to non-smokers (n=7), associations with youth culture (n=6), depictions of youth using ECs (n=6) or media targeting youth (n=5).

CONCLUSION

Among 10 top EC brand websites in England, marketing elements that might appeal to youth were commonly identified and CAP code compliance was low.