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Vogel EA, Ranker LR, Harrell PT, Hart JL, Kong G, McIntosh S, Meissner HI, Ozga JE, Romer D, Stanton CA. Characteristics of Adolescents' and Young Adults' Exposure to and Engagement with Nicotine and Tobacco Product Content on Social Media. JOURNAL OF HEALTH COMMUNICATION 2024; 29:383-393. [PMID: 38775659 DOI: 10.1080/10810730.2024.2355291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
To inform policy and messaging, this study examined characteristics of adolescents' and young adults' (AYAs') exposure to and engagement with nicotine and tobacco product (NTP) social media (SM) content. In this cross-sectional survey study, AYAs aged 13-26 (N=1,163) reported current NTP use, SM use frequency, and exposure to and engagement with SM content promoting and opposing NTP use (i.e. frequency, source[s], format[s], platform[s]). Participants who used NTPs (vs. did not use) were more likely to report having seen NTP content (p-values<.001). Prevalent sources were companies/brands (46.6%) and influencers (44.4%); prevalent formats were video (65.4%) and image (50.7%). Exposure to content promoting NTP use was prevalent on several popular platforms (e.g. TikTok, Instagram, Snapchat); exposure to content opposing NTP use was most prevalent on YouTube (75.8%). Among those reporting content engagement (i.e. liking, commenting on, or sharing NTP content; 34.6%), 57.2% engaged with influencer content. Participants reported engaging with content promoting and opposing NTP use on popular platforms (e.g. TikTok, Instagram, YouTube). Participants with (versus without) current NTP use were significantly more likely to use most SM platforms and to report NTP content exposure and engagement (p-values<.05). Results suggest that NTP education messaging and enforcement of platforms' content restrictions are needed.
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Affiliation(s)
- Erin A Vogel
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lynsie R Ranker
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Paul T Harrell
- Division of Community Health & Research, Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Joy L Hart
- Department of Communication, College of Arts and Sciences; Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Scott McIntosh
- Division of Social & Behavioral Sciences, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Helen I Meissner
- Office of Disease Prevention, National Institutes of Health, Bethesda, Maryland, USA
| | - Jenny E Ozga
- Behavioral Health & Health Policy, Westat, Rockville, Maryland, USA
| | - Dan Romer
- University of Pennsylvania Annenberg School for Communication, Philadelphia, Pennsylvania, USA
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Lee J, Ouellette RR, Morean ME, Kong G. Adolescents and Young Adults Use of Social Media and Following of e-Cigarette Influencers. Subst Use Misuse 2024; 59:1424-1430. [PMID: 38755112 DOI: 10.1080/10826084.2024.2352620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND With high rates of both e-cigarette and social media use among adolescents and young adults (AYAs), social media influencers who promote e-cigarettes are particularly concerning but are understudied. We examined the association between AYAs' use of 11 different social media platforms (e.g. Facebook, Twitter, Instagram, TikTok, and YouTube) and exposure to social media e-cigarette influencers. OBJECTIVES From November 2022 to February 2023, we conducted an online, US national survey of AYAs (14-29 years) who endorsed past-30-day e-cigarette use. We used binomial logistic regression to examine associations between the frequency of use of each social media platform and following e-cigarette influencers, controlling for age, sex, race, ethnicity, e-cigarette use frequency, and other tobacco and substance use (i.e., alcohol and cannabis). The model was stratified by adolescents (14-17 years; n = 293) and young adults (18-29 years; n = 654). RESULTS The most frequently used social media platforms were Snapchat, TikTok and Instagram among adolescents, and YouTube, Instagram and TikTok among young adults. In adjusted models, following e-cigarette influencers was associated with more frequent use of TikTok (adjusted odds ratio [95% CI]; 1.33 [1.05, 1.68]) and Pinterest (1.18 [1.02, 1.38]) among adolescents, and more frequent use of Twitter (1.17 [1.06, 1.29]) among young adults. CONCLUSIONS The use of different platforms was associated with exposure to e-cigarette influencers: TikTok and Pinterest among adolescents and Twitter among young adults. These findings can inform tobacco regulatory policy and social media platform restrictions of e-cigarette influencers on the platforms that are popular among AYAs.
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Affiliation(s)
- Juhan Lee
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rachel R Ouellette
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Meghan E Morean
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Grace Kong
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Li W, Kong G, Davis DR, Bold KW, Krishnan-Sarin S, Camenga DR, Morean ME. Sources of exposure to non-tobacco nicotine electronic nicotine delivery systems and associations with susceptibility to use and use behaviors among young adults in the United States. PLoS One 2024; 19:e0299533. [PMID: 38718067 PMCID: PMC11078344 DOI: 10.1371/journal.pone.0299533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/12/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION The Electronic Nicotine Delivery Systems (ENDS) industry recently introduced non-tobacco nicotine (NTN), which is not tobacco-derived and is often marketed as "tobacco-free nicotine." Given its novelty, it is important to understand where young adults learn about NTN ENDS. This study examined sources of exposure to NTN ENDS and relationships with NTN ENDS use and susceptibility. METHODS We analyzed online survey data collected in Fall 2021 from 642 young adults (18-25 years) who had heard of NTN ENDS. We assessed 9 sources of NTN ENDS exposure (e.g., retail stores, social media) and examined associations between sources of exposure and NTN current (past-month) use, lifetime (non-current) use, and susceptibility to use, adjusting for demographics and other tobacco product use. RESULTS Participants reported current NTN ENDS use (37.4%), lifetime use (12.0%), susceptibility (18.5%), or no susceptibility to use (32.1%). The most common sources of NTN ENDS exposure were retail stores (87.7%) and social media (81.0%). Exposure to NTN ENDS via social media was associated with greater odds of current NTN ENDS use (vs. no susceptibility) (aOR = 1.83, 95%CI: 1.02-3.28). Exposure via online streaming platforms was associated with greater odds of current (aOR = 1.75, 95%CI: 1.08-2.82) and lifetime NTN ENDS use (aOR = 2.42, 95%CI: 1.25-4.68). CONCLUSIONS Young adults were exposed to and learned about NTN ENDS from diverse sources, primarily retail shops and social media. Further, exposure via social media and streaming platforms were associated with NTN ENDS use. Future studies should explore the content of NTN information from various sources to inform prevention efforts.
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Affiliation(s)
- Wei Li
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Danielle R Davis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | | | - Deepa R Camenga
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Meghan E Morean
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
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Kong G, Laestadius L, Vassey J, Majmundar A, Stroup AM, Meissner HI, Ben Taleb Z, Cruz TB, Emery SL, Romer D. Tobacco promotion restriction policies on social media. Tob Control 2024; 33:398-403. [PMID: 36328589 PMCID: PMC10154427 DOI: 10.1136/tc-2022-057348] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022]
Abstract
Tobacco promotion is prolific on social media, with each platform setting their own restrictions on tobacco promotion and sales. We evaluated the policies related to tobacco product promotion and sales on 11 sites that are popular with youth in May 2021: Discord, Facebook, Instagram, Pinterest, Reddit, Snapchat, TikTok, Tumblr, Twitch, Twitter and YouTube. Nine of the 11 sites prohibited paid advertising for tobacco products. However, only three of them clearly prohibited sponsored content (ie, social influencers) that promotes tobacco. Six platforms restricted content that sells tobacco products and three tried to prohibit underage access to content that promotes or sells tobacco products. Although most platform policies prohibited paid tobacco advertising, few addressed more novel strategies, such as sponsored/influencer content and few had age-gating to prevent youth access. There is a pressing need to regulate tobacco promotion on social media platforms.
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Affiliation(s)
- Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Linnea Laestadius
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Julia Vassey
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Anuja Majmundar
- Tobacco Control Research, American Cancer Society, Inc, Atlanta, Georgia, USA
| | | | - Helen I Meissner
- Office of Disease Prevention, National Institutes of Health, Bethesda, Maryland, USA
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, USA
| | - Tess Boley Cruz
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Sherry L Emery
- Social Data Collaboratory, NORC at the University of Chicago, Chicago, Illinois, USA
| | - Dan Romer
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ma S, Kaareen A, Park H, He Y, Jiang S, Qiu Z, Xie Z, Li D, Chen J, O'Connor RJ, Fong GT, Shang C. How to Identify e-Cigarette Brands Available in the United States During 2020-2022: Development and Usability Study. JMIR Form Res 2024; 8:e47570. [PMID: 38416562 PMCID: PMC10938231 DOI: 10.2196/47570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/31/2023] [Accepted: 01/30/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Prior studies have demonstrated that the e-cigarette market contains a large number of brands. Identifying these existing e-cigarette brands is a key element of market surveillance, which will further assist in policy making and compliance checks. OBJECTIVE To facilitate the surveillance of the diverse product landscape in the e-cigarette market, we constructed a semantic database of e-cigarette brands that have appeared in the US market as of 2020-2022. METHODS In order to build the brand database, we searched and compiled e-cigarette brands from a comprehensive list of retail channels and sources, including (1) e-liquid and disposable brands sold in web-based stores, (2) e-cigarette brands sold in brick-and-mortar stores and collected by the Nielsen Retail Scanner Data, (3) e-cigarette brands compiled by Wikipedia, (4) self-reported e-cigarette brands from the 2020 International Tobacco Control Four-Country Smoking and Vaping (ITC 4CV) US survey, and (5) e-cigarette brands on Twitter. We also estimated the top 5 e-cigarette brands by sales volume in brick-and-mortar stores, by the frequency and variety of offerings in web-based shops, and by the frequency of self-reported brands from the 2020 ITC 4CV US survey. RESULTS As of 2020-2022, a total of 912 e-cigarette brands have been sold by various retail channels. During 2020-2022, the top 5 brands are JUUL, vuse, njoy, blu, and logic in brick-and-mortar stores; blu, king, monster, twist, and air factory for e-liquids in web-based stores; hyde, pod mesh, suorin, vaporlax, and xtra for disposables sold in web-based stores; and smok, aspire, vaporesso, innokin, and eleaf based on self-reported survey data. CONCLUSIONS As the US Food and Drug Administration enforces the premarket tobacco market authorization, many e-cigarette brands may become illegal in the US market. In this context, how e-cigarette brands evolve and consolidate in different retail channels will be critical for understanding the regulatory impacts on product availability. Our semantic database of e-cigarette brands can serve as a useful tool to monitor product and marketplace development, conduct compliance checks, assess manufacturers' marketing behaviors, and identify regulatory impacts.
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Affiliation(s)
- Shaoying Ma
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Aadeeba Kaareen
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Hojin Park
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Yanyun He
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Shuning Jiang
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Zefeng Qiu
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Zidian Xie
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Dongmei Li
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Jian Chen
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Ce Shang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Duan Z, Romm KF, Wang Y, Huang J, Berg CJ. Exposure to E-Cigarette Advertisements or Reviews and E-Cigarette Use Progression: A Longitudinal Examination of Short-Term and Long-Term Associations among US Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:123. [PMID: 38397614 PMCID: PMC10887947 DOI: 10.3390/ijerph21020123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/25/2024]
Abstract
Limited research has investigated the impact of e-cigarette advertising and reviews on the progression of e-cigarette use among young adults in the US. This study utilized five-wave longitudinal data (2018-2020) with 3006 young adults aged 18-34, reporting exposure to e-cigarette advertisements or reviews at Wave 1 (W1) and W3. Generalized estimating equations (GEE) were used to examine the prospective associations between frequent exposure to e-cigarette advertisements or reviews and e-cigarette use progression in four groups: never users (n = 1271 at W1), former users (previously used but quit ≥ 6 months ago, n = 422 at W1), recent former users (used in the past 6 months but not in the past month, n = 186 at W1), and current users (used in the past month, n = 1127 at W1). Among baseline former users, frequent exposure to e-cigarette reviews was associated with current use at 6-month follow-up (aOR = 4.40, 95%CI = 1.46-13.29). Among baseline current users, frequent exposure to e-cigarette reviews was associated with increased days of use at 6-month follow-up (IRR = 1.20, 95%CI = 1.07-1.34) and 12-month follow-up (IRR = 1.18, 95%CI = 1.03-1.35). E-cigarette reviews may contribute to relapse among recent former users and increased usage frequency among current users, highlighting the need for enhanced e-cigarette promotional activity regulation.
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Affiliation(s)
- Zongshuan Duan
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Katelyn F. Romm
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73126, USA;
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; (Y.W.); (C.J.B.)
| | - Jidong Huang
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA 30302, USA;
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; (Y.W.); (C.J.B.)
- George Washington Cancer Center, George Washington University, Washington, DC 20052, USA
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Czaplicki L, Patel D, Jewler K, Moran MB. Use of Brand Engagement Appeals in US Cigarette and E-Cigarettes Ads (2019-2020). Subst Use Misuse 2024; 59:832-839. [PMID: 38247155 DOI: 10.1080/10826084.2024.2305791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Background: The tobacco industry has historically used brand engagement - communication tactics companies use to increase customer attachment to a brand and brand loyalty - to recruit and retain consumers. Limited information is available to assess the brand engagement tactics used to promote the two most popular tobacco products in the US - cigarettes and electronic cigarettes (e-cigarettes) - across different advertising platforms (e.g., direct-to-consumer (DTC), social media). Material and methods: We acquired 520 cigarette and 5,502 e-cigarette ads that ran in the US January 2019 to December 2020 from market research firms (Kantar, Numerator), Rutger's University ad surveillance website (trinketsandtrash.org), and branded social media accounts. Ads were double-coded for eight types of brand engagement tactics: Price Promotion, Sweepstakes, Mobile App, Email/Mail List, Free Gift, Social Media engagement request, Sponsored Events, and Auto-Ship subscription program. We report presence of brand engagement tactics by product type and advertising platform. Results: Overall, 62.9% of cigarette ads and 49.9% of e-cigarette ads contained at least one brand engagement tactic. For cigarette ads, the most common tactics were Sweepstakes and Mobile App requests, which were most commonly featured in DTC ads. For e-cigarettes, the most common tactic was Price Promotion which was featured in most DTC and online e-cigarette ads. Conclusions: Brand engagement was common in this sample of cigarette and e-cigarette ads. Our findings highlight key differences in the type of brand engagement tactic used to promote each product on different advertising platforms. Results can inform continued advertising surveillance studies and regulatory efforts.
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Affiliation(s)
- Lauren Czaplicki
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kay Jewler
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Meghan B Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Chacon L, Mitchell G, Golder S. The commercial promotion of electronic cigarettes on social media and its influence on positive perceptions of vaping and vaping behaviours in Anglophone countries: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002736. [PMID: 38232105 DOI: 10.1371/journal.pgph.0002736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/30/2023] [Indexed: 01/19/2024]
Abstract
There is ongoing scientific and policy debate about the role e-cigarettes play in tobacco control, with concerns centring around unknown long-term effects, and the potential industry co-option of harm reduction efforts, including marketing to youths. There is substantial evidence of the influence of conventional cigarette promotion on smoking behaviours in Anglophone countries, and the popularity of social networking sites, as well as the lack of marketing regulations on the commercial promotion of electronic cigarettes online, suggest an urgent need to explore this topic further. This scoping review aims to map the existing evidence related to the influence of e-cigarette commercial promotion on social media on positive perceptions of vaping and vaping behaviours in core Anglophone countries. Searches were conducted in CENTRAL, Cochrane Database of Systematic Reviews (CDSR), Embase, Epistemonikos, MEDLINE, PsycINFO and Science Citation Index, on the 21st of July 2022. From 1,385 studies, 11 articles were included in the final review, using diverse study designs, including focus groups, content analysis, cross-sectional studies, and experiments. The studies were primarily based in the U.S. and evidenced the association between the commercial promotion of e-cigarettes on social media with positive perceptions of vaping and vaping behaviours, particularly among young people, addressing diverse themes including celebrities' sponsorship, e-liquid appeal (including flavours and nicotine levels), users' engagement with ads, and other marketing strategies. Further, social networking sites commercially promoting e-cigarettes might increase positive attitudes towards vaping and vaping behaviours, particularly among youths. Future research should be conducted in broader settings, incorporate larger and diverse sample sizes, ensure research transparency, cover multiple social networking sites, emphasize ecological validity, and foment longitudinal studies.
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Affiliation(s)
- L Chacon
- Department of Health Sciences, University of York, Heslington, United Kingdom
| | - G Mitchell
- Department of Health Sciences, University of York, Heslington, United Kingdom
| | - S Golder
- Department of Health Sciences, University of York, Heslington, United Kingdom
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Johannes BL, Ortiz SE. How Facebook is used to promote ENDS products near four Big 10 universities: A qualitative analysis. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:210-218. [PMID: 35171078 PMCID: PMC9378756 DOI: 10.1080/07448481.2022.2027425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 11/04/2021] [Accepted: 12/26/2021] [Indexed: 06/14/2023]
Abstract
Objective: Electronic Nicotine Delivery System (ENDS) proprietors strategically placed near college campuses and pervasive marketing on social media platforms, such as Facebook, are critical to the tobacco industry's effort to acquire new young adult users. Understanding the themes used on Facebook to promote ENDS products to college students is necessary to develop public health messaging to combat the vaping epidemic.Methods: We identified 15 ENDS proprietors located near four Big 10 universities and qualitatively analyzed a random sample of their Facebook posts (n = 405) to identify emerging themes using a grounded theory approach.Results: ENDS proprietors in college towns use Facebook to deploy promotional messaging (n = 319), to market ENDS products as a means of celebration (n = 40), to establish a sense of community (n = 155) among ENDS users, to make marijuana references (n = 36), and to advocate (n = 27) for ENDS products.Conclusions: These themes may increase social acceptability and use of ENDS products among college students.
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Affiliation(s)
- Bobbie L. Johannes
- Population Studies Center, University of Michigan, Ann Arbor, United States
| | - S. E. Ortiz
- Department of Health Policy and Administration, Penn State University, University Park, United States
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Duan Z, Abroms LC, Cui Y, Wang Y, LoParco CR, Levine H, Bar-Zeev Y, Khayat A, Berg CJ. Exposure to e-cigarette advertisements and non-advertising content in relation to use behaviors and perceptions among US and Israeli adults. Tob Prev Cessat 2023; 9:35. [PMID: 38033881 PMCID: PMC10685321 DOI: 10.18332/tpc/173558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION As e-cigarette marketing strategies diversify, it is important to examine exposure to and impact of e-cigarette advertisements and non-advertising content (e.g. on social media) via multiple media channels among adults in different regulatory contexts. METHODS Using 2021 cross-sectional data among 2222 adults in the US (n=1128) and Israel (n=1094), multivariable regression examined past-month e-cigarette advertisement and non-advertising content exposure in relation to past-month e-cigarette use (logistic regression), as well as use intentions and risk perceptions (linear regressions), controlling for sociodemographics and tobacco use. RESULTS Overall, 20.3% reported past-month e-cigarette use (15.5% US, 25.2% Israel), 46.1% any advertisement exposure (28.7% digital media, 25.2% traditional media, 16.8% retail settings), and 34.1% any non-advertising exposure (19.4% social media, 13.6% websites, 12.3% movie/television/theater, 5.8% radio/podcasts). Exposure to digital media advertisements (AOR=1.95; 95% CI: 1.42-2.66), traditional media advertisements (AOR=2.00; 95% CI=1.49-2.68), and social media non-advertising (AOR=1.72; 95% CI: 1.25-2.36) correlated with e-cigarette use. Exposure to traditional media advertisements (β=0.23; 95% CI: 0.08-0.38) and social media non-advertising (β=0.26; 95% CI: 0.09-0.43) correlated with use intentions. Exposure to digital media advertisements (β= -0.32; 95% CI: -0.57 - -0.08), retail setting advertisements (β= -0.30; 95% CI: -0.58 - -0.03), and radio/podcast non-advertising (β= -0.44; 95% CI: -0.84 - -0.03) correlated with lower perceived addictiveness. Radio/podcast non-advertising exposure (β= -0.50; 95% CI: -0.84 - -0.16) correlated with lower perceived harm. However, retail setting advertisement exposure was associated with e-cigarette non-use (AOR=0.61; 95% CI: 0.42-0.87), and traditional media advertisement (β=0.38; 95% CI: 0.15-0.61) and social media non-advertising exposure (β=0.40; 95% CI: 0.14-0.66) correlated with greater perceived addictiveness. CONCLUSIONS E-cigarette-related promotional content exposure across media platforms impacts perceptions and use, thus warranting regulation.
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Affiliation(s)
- Zongshuan Duan
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, United States
| | - Lorien C. Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States
- George Washington Cancer Center, George Washington University, Washington, United States
| | - Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States
- George Washington Cancer Center, George Washington University, Washington, United States
| | - Cassidy R. LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Centre, Jerusalem, Israel
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Centre, Jerusalem, Israel
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Centre, Jerusalem, Israel
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States
- George Washington Cancer Center, George Washington University, Washington, United States
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Duan Z, Levine H, Bar-Zeev Y, Cui Y, LoParco CR, Wang Y, Abroms LC, Khayat A, Berg CJ. The impacts of electronic cigarette health warning labels on use intentions and perceptions: A cross-sectional study of US and Israeli adults who use tobacco. J Public Health Res 2023; 12:22799036231214396. [PMID: 38020219 PMCID: PMC10666698 DOI: 10.1177/22799036231214396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Background Health warning labels (HWLs) are evidence-based tobacco control strategies; however, their application to e-cigarettes and related impacts (e.g. on perceived risk), including across countries with different regulations, are understudied. Design and Methods Using 2021 survey data from 927 US and Israeli adults reporting past-month tobacco use, multivariate analyses examined: (1) sociodemographics in relation to self-reported impact of e-cigarette HWLs (i.e. more concerned about e-cigarette use, reassured, no effect) among those who noticed e-cigarette HWLs (multinomial regressions); and (2) HWL impacts in relation to use intentions and perceived addictiveness and harm (linear regressions). Results Among those who noticed HWLs (n = 835, 90.1%), 34.1% reported HWLs resulted in greater concern about e-cigarette use, 45.5% no effect, and 20.4% reassurance. Factors associated with greater concern (vs no effect) included e-cigarette non-use (vs use; aOR = 1.69, 95% CI:1.22, 2.38), US (vs Israel) resident (aOR = 1.65, 95% CI:1.16, 2.34), age 18-25 (vs 36-45; aOR = 1.72, 95% CI:1.11, 2.67), and more education (aOR = 1.85, 95% CI:1.30, 2.63). Factors associated with being reassured (vs no effect) included use of cigarettes (aOR = 1.71, 95% CI:1.06, 2.75), e-cigarettes (aOR = 2.64, 95% CI:1.77, 3.94), and other tobacco (aOR = 2.11, 95% CI:1.39, 3.21), and Israeli resident (aOR = 2.33, 95% CI:1.47, 3.70). Not noticing HWLs (vs no effect) correlated with lower intentions (β = -0.44, 95% CI:-0.87, -0.01), perceived addictiveness (β = -0.61, 95% CI:-1.05, -0.18), and harm (β = -0.56, 95% CI:-0.95, -0.18); reassurance correlated with greater use intentions (β = 0.48, 95% CI:0.12, 0.83); and greater concern was unassociated with use intentions or perceived risk. Conclusion Effects of differing e-cigarette HWLs in distinct subpopulations warrant research. Despite being noticed, they may have no effect or encourage e-cigarette use.
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Affiliation(s)
- Zongshuan Duan
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
| | - Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Cassidy R LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
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12
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Kong G, Lee J, Celentano M, Tang C, Geller A, Mead A, Landrum Sterling K. The Promotion of Premium Cigars on Social Media. Nicotine Tob Res 2023; 25:59-64. [PMID: 37506234 PMCID: PMC10380185 DOI: 10.1093/ntr/ntad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/21/2022] [Accepted: 05/10/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION The health effect of premium cigar smoking is determined by patterns of use and perceptions, which are shaped by marketing messages. The tobacco industry uses brand-owned media promotion on social media to market its product. However, premium cigar brands' promotion of their products on social media is unknown. AIMS AND METHODS Forty-seven premium cigar brands were reviewed. For each brand, we identified the social media accounts and examined the content of the 10 most recent posts of each social media platform to identify the marketing themes in July 2022. We also assessed the presence of age-gating and the dates of the posts. RESULTS Of the 47 brands, 65% (n = 31) had Facebook and Instagram, 56% (n = 27) had Twitter, 21% (n = 10) had YouTube, and 17% (n = 8) had "other" (e.g. LinkedIn and Pinterest) accounts. Age-gating across these platforms ranged from 0% to 49%. Marketing themes identified from 981 social media posts included product features, alcohol, holidays, events and festivals, discounts and sweepstakes, taste, family, quality, lounges and clubs, culture, innovation, masculinity, and "other" (e.g. fundraising for charity and celebrity endorsement). CONCLUSIONS Premium cigar brands are using brand-owned social media to promote their products using similar strategies (e.g. discounts and sweepstakes) used by other tobacco industries but also using novel themes (e.g. fundraising for charity, events and festivals) to enhance engagement. Ongoing comprehensive surveillance of premium cigars' marketing is needed on social media to inform marketing restrictions to protect public health, including priority populations such as youth. IMPLICATIONS This study is the first to identify that premium cigar brands are promoting their brands and products on brand-owned social media, using diverse themes and strategies to engage and appeal to the public. Age gating of the promotional content on social media was low. Findings suggest that marketing restrictions to reduce the appeal of premium cigars among youth is needed to reduce tobacco-related harm.
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Affiliation(s)
- Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Juhan Lee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Mia Celentano
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Charis Tang
- Department of Psychiatry, School of Public-Dallas Campus, University of Texas Health Sciences Center, Dallas, TX, USA
| | - Amy Geller
- Department of Psychiatry, National Academies of Sciences, Engineering, and Medicine, Washington, DC, USA
| | - Aimee Mead
- Department of Psychiatry, National Academies of Sciences, Engineering, and Medicine, Washington, DC, USA
| | - Kymberle Landrum Sterling
- Department of Psychiatry, School of Public-Dallas Campus, University of Texas Health Sciences Center, Dallas, TX, USA
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13
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Wang Y, Xu YA, Wu J, Kim HM, Fetterman JL, Hong T, McLaughlin ML. Moralization of E-cigarette Use and Regulation: A Mixed-Method Computational Analysis of Opinion Polarization. HEALTH COMMUNICATION 2023; 38:1666-1676. [PMID: 35057690 DOI: 10.1080/10410236.2022.2027640] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
E-cigarette use, or vaping, is undergoing a process of moralization in which issues about vaping evolve from being morally neutral to having discernible moral implications. Using Moral Foundations Theory, this study compared the moral narratives underlying polarized views about e-cigarette use and regulation. We integrated computational and human strategies by conducting the Chow test on the time series data and classification, topic modeling, and Chi-square tests on posts (N = 2,669) from 26 pro-vaping and 19 anti-vaping Facebook Pages. The observation period (August 1, 2019 to March 5, 2020) encompassed the outbreak of "e-cigarette or vaping product use associated lung injury" (EVALI), deaths and subsequent legislation. Results revealed that pro-vaping posts were more likely than anti-vaping posts to mention Fairness/cheating and Authority/subversion, involving a conspiracy belief in an "e-cigarettes vs. Big Tobacco" rivalry, while anti-vaping posts were more likely to mention Sanctity/degradation. There were no significant differences between pro-vaping and anti-vaping posts in the likelihood of mentioning Care/harm or Loyalty/betrayal. Nevertheless, according to the topic modeling results, the use of moral foundations varied between pro-vaping and anti-vaping narratives, with the meanings of Care/harm and Loyalty/betrayal dependent on the post author's group affiliation. Health interventions can tailor persuasive messages to different moral values and debunk misinformation about public health policies to mitigate the vaping epidemic. Theoretical implications are also discussed.
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Affiliation(s)
- Yunwen Wang
- Annenberg School for Communication and Journalism, University of Southern California
| | - Yusi Aveva Xu
- Annenberg School for Communication and Journalism, University of Southern California
| | - Jiaxi Wu
- College of Communication, Boston University
| | - Hye Min Kim
- Annenberg School for Communication and Journalism, University of Southern California
| | - Jessica L Fetterman
- Evans Department of Medicine and Whitaker Cardiovascular Institute, School of Medicine, Boston University
| | - Traci Hong
- College of Communication, Boston University
| | - Margaret L McLaughlin
- Annenberg School for Communication and Journalism, University of Southern California
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14
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Berg CJ, LoParco CR, Cui Y, Pannell A, Kong G, Griffith L, Romm KF, Yang YT, Wang Y, Cavazos-Rehg PA. A review of social media platform policies that address cannabis promotion, marketing and sales. Subst Abuse Treat Prev Policy 2023; 18:35. [PMID: 37337216 PMCID: PMC10278361 DOI: 10.1186/s13011-023-00546-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Cannabis marketing exposure via social media may impact use in youth and young adults. Most states with recreational cannabis lack policies regarding social media-based marketing. Thus, we examined such policies among prominent platforms, particularly those popular among youth and young adults. METHODS In September-October 2022, 3 research team members extracted policies applying to the general community, advertising, and any specific content regarding drug-related content for 11 social media sites: Discord, Facebook, Instagram, Pinterest, Reddit, Snapchat, TikTok, Tumblr, Twitch, Twitter, and YouTube. Using inductive thematic analysis, they then dual-coded restrictions on cannabis-related content (e.g., paid advertising, unpaid promotion, sales). Descriptive analyses were conducted. RESULTS Ten (all except TikTok) referenced cannabis/marijuana, 7 (all except Discord, Instagram, TikTok, and YouTube) distinguished different cannabis-derived products, and 5 (Reddit, Snapchat, TikTok, Tumblr, Twitter) noted jurisdictional differences in cannabis regulations/legality. All prohibited sales, 9 (all except Snapchat and Tumblr) prohibited paid advertising, and 4 (Discord, Reddit, Snapchat, TikTok) prohibited unpaid promotion (e.g., user-generated content). All restricted underage access to cannabis-related content. However, policies varied and were ambiguous regarding how "promotion" was defined, whether/how jurisdictional differences in legality were addressed, how businesses may interact on social media, barriers implemented to inhibit the facilitation of sales, and enforcement protocols. CONCLUSIONS Social media policies regarding cannabis marketing are ambiguous and may facilitate cannabis marketing, promotion, sales, and underage exposure, thus compounding concerns regarding insufficient governmental regulations. Greater specificity in social media cannabis-related policies and enforcement is needed.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000C, Washington, DC, 20052, USA.
- George Washington Cancer Center, George Washington University, 2121 I St NW, Washington, DC, 20052, USA.
| | - Cassidy R LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000C, Washington, DC, 20052, USA
| | - Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000C, Washington, DC, 20052, USA
| | - Alexandria Pannell
- Department of Global Health, Milken Institute School of Public Health, George Washington University, 2121 I St NW, Washington, DC, 20052, USA
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, 06519, USA
| | - Lynniah Griffith
- Wellesley College, 106 Central Street, Wellesley, MA, 02481, USA
| | - Katelyn F Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center; Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Y Tony Yang
- George Washington Cancer Center, George Washington University, 2121 I St NW, Washington, DC, 20052, USA
- Center for Health Policy and Media Engagement, School of Nursing, George Washington University, 1919 Pennsylvania Ave NW #500, Washington, DC, 20006, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000C, Washington, DC, 20052, USA
- George Washington Cancer Center, George Washington University, 2121 I St NW, Washington, DC, 20052, USA
| | - Patricia A Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA
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15
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Smith MJ, Buckton C, Patterson C, Hilton S. User-generated content and influencer marketing involving e-cigarettes on social media: a scoping review and content analysis of YouTube and Instagram. BMC Public Health 2023; 23:530. [PMID: 36941553 PMCID: PMC10029293 DOI: 10.1186/s12889-023-15389-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 03/07/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Evidence suggests that experimentation with e-cigarettes among young people is increasing. Social media is widely used by young people with user-generated content and influencer marketing particularly influential in promoting products. This paper documents a snapshot of online user-generated content and influencer marketing related to e-cigarettes on YouTube and Instagram. METHODS Scoping review of relevant e-cigarette-related content on two social media platforms popular with youths, YouTube and Instagram, between June and August 2021. Content analysis was undertaken to examine text, audio, and video content, recording age restrictions, health warnings, page characteristics, and post characteristics. Narrative post content was coded using a coding frame that was developed inductively in response to emergent categories. RESULTS Vaping was portrayed positively on social media; of the posts analysed, 86.5% (n = 90 of 104) of Instagram posts and 66.0% (n = 64 of 97) of YouTube videos. Warnings about age restrictions and health (e.g., nicotine addiction/toxicity) did not feature in the majority of posts; 43.3% (n = 42) of YouTube videos (n = 42) contained an age warning compared to 20.2% of Instagram posts (n = 21). While 25.8% (n = 25) of YouTube videos and 21.2% of Instagram (n = 22) posts contained a health warning. CONCLUSION Of concern is the fact that the vast majority of YouTube and Instagram content about e-cigarettes promoted their use, and typically the content does not contain age and/or health warnings. These findings may highlight a priority for governmental policy to restrict the ability of marketers to reach youths with social media content promoting e-cigarettes.
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Affiliation(s)
- Marissa J Smith
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | - Christina Buckton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Chris Patterson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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16
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Lyu JC, Huang P, Jiang N, Ling PM. A Systematic Review of E-Cigarette Marketing Communication: Messages, Communication Channels, and Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159263. [PMID: 35954623 PMCID: PMC9367763 DOI: 10.3390/ijerph19159263] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/17/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022]
Abstract
Marketing plays a key role in increasing the popularity of e-cigarettes. We conducted a systematic review of the existing literature published between 2003 and 2019 in eight databases to describe e-cigarette marketing communication messages by communication channels and marketing communication strategies. Forty-one articles were included in the analysis after screening. Ten key messages were identified. Cessation and health-related benefits (each n = 31, 75.6%) were the most reported marketing communication messages, followed by sociability/lifestyle and use experience. The Internet (n = 32, 78.0%) was the most studied communication channel compared to print, TV/movie/radio, and point-of-sales (POS)/retail stores. The most studied marketing communication strategies were advertising (n = 28, 68.3%), followed by public relations and sales promotion. Published research studies reported consistent messages about e-cigarettes across communication channels and marketing communication strategies. Claims of smoking cessation and health-related benefits were widely identified in the existing literature. While therapeutic claims are prohibited, soft sell messages, such as social appeals, for which regulatory reach may be limited, may require educational campaigns. Internet marketing has attracted much attention, with limited studies on messages in print, TV/movie/radio, and POS/retail stores. The lack of studies of direct marketing messaging indicates a big gap between industry spending and academic research; more studies of messaging utilizing this strategy are needed.
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Affiliation(s)
- Joanne Chen Lyu
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA 94117, USA;
- Correspondence:
| | - Peiyi Huang
- Department of Psychology, School of Social Sciences, University of Mannheim, 68159 Mannheim, Germany;
| | - Nan Jiang
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY 10016, USA;
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA 94117, USA;
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17
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Barrientos-Gutierrez I, Gallegos-Carrillo K, Cruz-Jimenez L, Rodriguez-Bolaños R, Arillo-Santillán E, Thrasher JF. Exposure to e-cigarette advertising and provaping websites, and the social acceptability of their use among nicotine users. Rev Panam Salud Publica 2022; 46:e87. [PMID: 36211245 PMCID: PMC9534350 DOI: 10.26633/rpsp.2022.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives To evaluate the prevalence of exposure to Internet communications on and advertising of electronic cigarettes (e-cigarettes) and their association with perceptions of the social acceptability of e-cigarettes in Mexico. Methods Data were analyzed from eight surveys (2018-2021) of an online sample of Mexican adult (> 18 years) smokers and dual users (of combustible and electronic cigarettes). Self-reported exposure to e-cigarette advertising across various marketing channels was assessed, as well as visits to e-cigarette websites. Logistic regression analysis was used to evaluate the association between perceptions of the social acceptability of e-cigarette use and level of advertising exposure and visits to e-cigarette websites. Results The Internet and outside e-cigarette stores were where exposure to advertising most occurred, as reported by 47.4% and 46.8% of respondents, respectively. Respondents who noticed e-cigarette advertisements on the Internet (adjusted odds ratio (OR) 1.43, 95% confidence intervals (CI) 1.25, 1.63), outside e-cigarette stores (adjusted OR 1.31, 95% CI 1.14, 1.50), and in temporary outlets (adjusted OR 1.16, 95% CI 1.01, 1.34), and those who visited e-cigarette websites (adjusted OR 1.48, 95% CI 1.25, 1.76) were more likely to perceive e-cigarettes as socially acceptable. Noticing advertisements across more channels was also associated with higher perceived social acceptability of e-cigarette use. Conclusions Being exposed to e-cigarette marketing, either online or through traditional marketing channels, is associated with perceived social acceptability of e-cigarette use, as is contact with provaping sites. Regulatory options to avoid the proliferation of promotional websites disguised as opinion or user sites need to be considered.
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Affiliation(s)
- Inti Barrientos-Gutierrez
- Center for Evaluation and Survey ResearchMexican National Institute of Public HealthCuernavacaMexicoCenter for Evaluation and Survey Research, Mexican National Institute of Public Health, Cuernavaca, Mexico.
| | - Katia Gallegos-Carrillo
- Epidemiology and Health Services Research UnitMexican Institute of Social SecurityCuernavacaMexicoEpidemiology and Health Services Research Unit, Mexican Institute of Social Security, Cuernavaca, Mexico.
| | - Lizeth Cruz-Jimenez
- Center for Evaluation and Survey ResearchMexican National Institute of Public HealthCuernavacaMexicoCenter for Evaluation and Survey Research, Mexican National Institute of Public Health, Cuernavaca, Mexico.
| | - Rosibel Rodriguez-Bolaños
- Population Health Research CenterMexican National Institute of Public HealthCuernavacaMexicoPopulation Health Research Center, Mexican National Institute of Public Health, Cuernavaca, Mexico.
| | - Edna Arillo-Santillán
- Population Health Research CenterMexican National Institute of Public HealthCuernavacaMexicoPopulation Health Research Center, Mexican National Institute of Public Health, Cuernavaca, Mexico.
| | - James F. Thrasher
- Arnold School of Public HealthUniversity of South CarolinaColumbia, SCUnited States of AmericaArnold School of Public Health, University of South Carolina, Columbia, SC, United States of America.
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