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Shim SY, Lee H, Kim S, Huong NTT, Lee YM, Thị PL, Loan BTT. Association of Smoking Media Literacy with Vietnamese and South Korean Adolescents' Susceptibility to Smoking. J Sch Nurs 2024; 40:391-400. [PMID: 35844147 DOI: 10.1177/10598405221112105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Studies on how smoking media literacy (SML) is associated with susceptibility to smoking among adolescents in South Korea and Vietnam are scarce. Thus, we examined the association of SML with susceptibility to smoking among adolescents in these countries to initiate a collaborative global health program. In total, 460 adolescents (Vietnam: 277, South Korea: 183) aged 15-18 completed an online cross-sectional survey. SML was measured using the 15-item SML scale. Susceptibility to smoking was measured by three questions on future smoking and if offered a cigarette by a friend. A multiple logistic regression model explored the association of SML with susceptibility to smoking. The study revealed that higher SML was significantly associated with lower susceptibility to smoking among Vietnamese, but not South Korean adolescents. Further studies to identify pathways between other factors associated with SML and susceptibility to smoking are needed to develop culture-specific intervention strategies for smoking prevention.
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Affiliation(s)
- Sun Young Shim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Hyeonkyeong Lee
- College of Nursing, Yonsei University, Seoul, Republic of Korea
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
| | - Sookyung Kim
- School of Nursing, Soonchunhyang University, Cheonan, Republic of Korea
| | | | - Young-Me Lee
- College of Science and Health, DePaul University, Chicago, IL, USA
| | - Phương Lê Thị
- Department of Nursing, Quang Tri Medical College, Quang Tri, Vietnam
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2
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Ranker LR, Wu J, Hong T, Wijaya D, Benjamin EJ, Bhatnagar A, Robertson RM, Fetterman JL, Xuan Z. Social media use, brand engagement, and tobacco product initiation among youth: Evidence from a prospective cohort study. Addict Behav 2024; 154:108000. [PMID: 38461745 PMCID: PMC11135121 DOI: 10.1016/j.addbeh.2024.108000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/19/2024] [Accepted: 02/24/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To evaluate whether frequent social media use and liking/following tobacco brand accounts was associated with increased risk of tobacco and polytobacco initiation over approximately 1-year follow-up among youth with no prior tobacco use. METHODS Associations between measures of social media engagement (daily social media use and liking/following tobacco brands) and tobacco initiation risk were examined using data from Waves 2 and 3 (2014-2015) of the US Population Assessment for Tobacco and Health study. Separate log-binomial models, accounting for missing data via multiple imputation and using propensity score adjustment to address confounding, estimated the adjusted relative risk (aRR) of any tobacco initiation and poly-use (2 + products) initiation at 1-year follow-up. RESULTS Among the 8,672 youth with no prior tobacco use (49.3% female, mean [SD] age 14.1 [1.7]), 63.5% used social media at least daily, and 3.3% reported liking/following ≥ 1 tobacco brands on social media. Those reporting daily or more frequent social media use (compared to less) were at increased risk for tobacco (aRR 1.67; 95% CI 1.38-2.02) and polytobacco initiation (aRR 1.32; 95% CI 0.98-1.78). Although results were imprecise, liking/following ≥ 1 tobacco brands on social media (versus none) was associated with tobacco (aRR 1.34; 95% CI 0.95-1.89) or polytobacco initiation (aRR 1.60; 95% CI 0.99-2.60). In sensitivity analyses, liking/following cigarette or cigarillo brands was associated with polytobacco initiation. CONCLUSIONS This study adds to a growing evidence-base describing the exposure of youth to tobacco-related social media content. Such content-often generated by tobacco companies-may contribute to youth tobacco initiation.
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Affiliation(s)
- Lynsie R Ranker
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 4th floor, Boston, MA 02118, USA.
| | - Jiaxi Wu
- College of Communication, Boston University, 640 Commonwealth Avenue, Boston, MA 02215, USA; Annenberg School for Communication, University of Pennsylvania, 3620 Walnut St, PA 19104, Philadelphia
| | - Traci Hong
- College of Communication, Boston University, 640 Commonwealth Avenue, Boston, MA 02215, USA
| | - Derry Wijaya
- Department of Computer Science, Boston University, 111 Cummington Mall, Boston, MA 02215, USA
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 725 Albany Street, Boston, MA 02118, USA; Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, 4th floor, Boston, MA 02118, USA
| | - Aruni Bhatnagar
- Department of Medicine, University of Louisville, 302 E Muhammad Ali Boulevard, KY 40202, Louisville; American Heart Association Tobacco Regulation and Addiction Center, 7272 Greenville Ave., Dallas, TX 75231, USA
| | - Rose M Robertson
- American Heart Association Tobacco Regulation and Addiction Center, 7272 Greenville Ave., Dallas, TX 75231, USA; Department of Medicine, School of Medicine, Vanderbilt University, 1161 21st Ave. S., Nashville 37232, TN, USA
| | - Jessica L Fetterman
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian & Avedisian School of Medicine, 700 Albany Street, Boston, MA 02118, USA
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 4th floor, Boston, MA 02118, USA
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Sritong C, Sawangproh W, Teangsompong T. Unveiling the adoption of metaverse technology in Bangkok metropolitan areas: A UTAUT2 perspective with social media marketing and consumer engagement. PLoS One 2024; 19:e0304496. [PMID: 38848432 PMCID: PMC11161105 DOI: 10.1371/journal.pone.0304496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/13/2024] [Indexed: 06/09/2024] Open
Abstract
As the metaverse emerges as a transformative digital realm, its adoption and integration into various aspects of society are subjects of increasing scholarly and practical interest. This research investigated the factors influencing the intention to use metaverse technology (IU) in Bangkok metropolitan areas, with a particular focus on the extended Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) framework, alongside the role of social media marketing (SMM) and consumer engagement (CE). To verify behavioral intention, gender, age, and experience are proposed as moderating factors affecting the constructs on individuals' behavioral intention of metaverse technology usage. The study collected data from 403 Thai internet users living in Bangkok and its surrounding areas using an online questionnaire. Subsequently, the PLS-SEM method was employed to validate the research model's robustness and reliability. Structural model analysis revealed significant relationships among constructs, highlighting SMM's direct influence on UTAUT2 (β = 0.787) and CE (β = 0.211). Serial mediation analyzes demonstrated a fully mediating role of SMM influencing UI through CE (β = 0.572) and UTAUT2 (β = 0.306). Moderation analyzes revealed the association between SMM and IU, mediated through UTAUT2 and CE, is moderated by age and experience. Additionally, the integration of PLS-SEM and artificial neural network (ANN) models underscored the accuracy and predictive power of the proposed framework. The findings of this study not only contribute to academic literature but also offer practical implications for marketers aiming to navigate the metaverse landscape effectively. They emphasize the pivotal role of UTAUT2 constructs and the subtle interplay between SMM, CE, and IU in shaping successful marketing strategies.
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Affiliation(s)
- Chaloempon Sritong
- Business Administration Program, School of Interdisciplinary Studies, Mahidol University (Kanchanaburi Campus), Kanchanaburi, Kanchanaburi Province, Thailand
| | - Weerachon Sawangproh
- Conservation Biology Program, School of Interdisciplinary Studies, Mahidol University (Kanchanaburi Campus), Kanchanaburi, Kanchanaburi Province, Thailand
| | - Teerapong Teangsompong
- Business Administration Program, School of Interdisciplinary Studies, Mahidol University (Kanchanaburi Campus), Kanchanaburi, Kanchanaburi Province, Thailand
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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 PMCID: PMC11229177 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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Nali MC, Purushothaman V, Li Z, Larsen MZ, Cuomo RE, Yang J, Mackey TK. Identification and Characterization of Illegal Sales of Cannabis and Nicotine Delivery Products on Telegram Messaging Platform. Nicotine Tob Res 2024; 26:771-779. [PMID: 38097394 DOI: 10.1093/ntr/ntad248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 11/01/2023] [Accepted: 12/08/2023] [Indexed: 05/23/2024]
Abstract
INTRODUCTION Unregulated and potentially illegal sales of tobacco, nicotine, and cannabis products have been detected on various social media platforms, e-commerce sites, online retailers, and the dark web. New end-to-end encrypted messaging services are popular among online users and present opportunities for marketing, trading, and selling of these products. The purpose of this study was to identify and characterize tobacco, nicotine, and cannabis selling activity on the messaging platform Telegram. METHODS The study was conducted in three phases: (1) identifying keywords related to tobacco, nicotine, and cannabis products for purposes of detecting Telegram groups and channel messages; (2) automated data collection from public Telegram groups; and (3) manual annotation and classification of messages engaged in marketing and selling products to consumers. RESULTS Four keywords were identified ("Nicotine," "Vape," "Cannabis," and "Smoke") that yielded 20 Telegram groups with 262 506 active subscribers. Total volume of channel messages was 43 963 unique messages that included 3094 (7.04%) marketing/selling messages. The most commonly sold products in these groups were cannabis-derived products (83.25%, n = 2576), followed by tobacco/nicotine-derived products (6.46%, n = 200), and other illicit drugs (0.77%, n = 24). A variety of marketing tactics and a mix of seller accounts were observed, though most appeared to be individual suppliers. CONCLUSIONS Telegram is an online messaging application that allows for custom group creation and global connectivity, but also includes unregulated activities associated with the sale of cannabis and nicotine delivery products. Greater attention is needed to conduct monitoring and enforcement on these emerging platforms for unregulated and potentially illegal cannabis and nicotine product sales direct-to-consumer. IMPLICATIONS Based on study results, Telegram represents an emerging platform that enables a robust cannabis and nicotine-selling marketplace. As local, state, and national tobacco control regulations continue to advance sales restrictions and bans at the retail level, easily accessible and unregulated Internet-based channels must be further assessed to ensure that they do not act as conduits for exposure and access to unregulated or illegal cannabis and nicotine products.
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Affiliation(s)
- Matthew C Nali
- Department of Anesthesiology, Division of Infectious Disease and Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA
- S-3 Research, San Diego, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
| | - Vidya Purushothaman
- Department of Anesthesiology, Division of Infectious Disease and Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA
- San Diego Supercomputer Center, University of California, San Diego, CA, USA
| | - Zhuoran Li
- S-3 Research, San Diego, CA, USA
- San Diego Supercomputer Center, University of California, San Diego, CA, USA
| | - Meng Zhen Larsen
- S-3 Research, San Diego, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
- San Diego Supercomputer Center, University of California, San Diego, CA, USA
| | - Raphael E Cuomo
- Department of Anesthesiology, Division of Infectious Disease and Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
| | - Joshua Yang
- Department of Public Health, California State University, Fullerton, CA, USA
| | - Tim K Mackey
- S-3 Research, San Diego, CA, USA
- Global Health Policy and Data Institute, San Diego, CA, USA
- Global Health Program, Department of Anthropology, University of California, San Diego, CA, USA
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Vassey J, Vogel EA, Unger JB. US adolescents' response to nicotine warning labels in influencer e-cigarette marketing social media posts: a survey-based randomised between-subject experiment. Tob Control 2024:tc-2023-058534. [PMID: 38749676 DOI: 10.1136/tc-2023-058534] [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: 11/29/2023] [Accepted: 04/25/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND E-cigarette promotional posts with misleading nicotine warning labels on social media may lower adolescents' risk perceptions of e-cigarettes. A between-subject experiment assessed effects of influencers' e-cigarette promotional posts with different nicotine warning labels on adolescents' e-cigarette harm perceptions, susceptibility to e-cigarette use and perceptions of influencer credibility. METHODS In 2022, adolescents (N=1864, Mage=17 (SD=0.6)) were randomised to view six images and videos featuring influencers promoting e-cigarettes in one of five experimental conditions: two conditions with a 'tobacco-free nicotine' warning label (placed on an e-cigarette in the post or at the top of the post), two conditions with the US Food and Drug Administration (FDA) nicotine warning label (on an e-cigarette in the post or at the top of the post (control)) and one no-label condition. Participants rated influencers' credibility (eg, honesty). Harm perceptions of, and susceptibility to use, e-cigarettes were then assessed. RESULTS Participants who viewed posts with the FDA warning label at the top of the post perceived influencers as more honest, trustworthy and informed than in all the other conditions. E-cigarette never-users who viewed posts with a 'tobacco-free nicotine' warning label pictured on an e-cigarette (compared with the FDA label at the top of a post) were more likely to report susceptibility to e-cigarette use (adjusted OR 1.79, 95% CI 1.17 to 2.73). CONCLUSIONS Alterations of the required nicotine warning labels can make them less effective in deterring e-cigarette use behaviour. Tobacco control authorities could increase enforcement of the FDA-required nicotine warning labels and harness influencers for antitobacco messaging.
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Affiliation(s)
- Julia Vassey
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Erin A Vogel
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, 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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Gomes MN, Reid JL, Hammond D. The effect of branded versus standardized e-cigarette packaging and device designs: an experimental study of youth interest in vaping products. Public Health 2024; 230:223-230. [PMID: 38429123 DOI: 10.1016/j.puhe.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES Standardized ('plain') packaging is effective in reducing the appeal of cigarettes among young people. This study examined the impact of plain packaging and brand imagery on interest in trying e-cigarettes among youth. STUDY DESIGN Experimental design. METHODS Two online experiments were conducted in February 2020 as part of the ITC Youth Tobacco & Vaping Survey, conducted with 13,624 16- to 19-year-olds in Canada, England, and the USA. In the between-group Experiment 1, participants were randomized to view a set of 3 e-cigarette brands, in either their original external packaging ('branded' condition) or standardized olive-green packaging ('standardized' condition), and asked to select the product they would be most interested in trying. The within-group Experiment 2 examined brand imagery directly on devices, including potential differences in appeal among subgroups. Each participant viewed 4 pod-style e-cigarette devices: one 'plain' and 3 in colourful 'skins'. Logistic regression models were conducted to test the effect of condition, adjusting for demographics, smoking and vaping status. RESULTS In Experiment 1, participants in the 'standardized' packaging condition were significantly more likely to indicate 'I have no interest in trying any of these products' (72.3%) than those in the 'branded' condition (66.9%, AOR 1.45, 95% CI 1.33-1.59). Experiment 2 results indicated differences in e-cigarette appeal by sex in the selection of male- and female-oriented designs, and by cannabis use for a Rastafarian-themed design. CONCLUSIONS Brand imagery on e-cigarettes can target products to specific subgroups. Removal of imagery, in the form of standardized packaging, has the potential to reduce interest in trying e-cigarettes among young people.
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Affiliation(s)
- M N Gomes
- School of Public Health Sciences, University of Waterloo, Canada
| | - J L Reid
- School of Public Health Sciences, University of Waterloo, Canada
| | - D Hammond
- School of Public Health Sciences, University of Waterloo, Canada.
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Lee DN, Liu J, Stevens H, Oduguwa K, Stevens EM. Does source matter? Examining the effects of health experts, friends, and social media influencers on young adult perceptions of Instagram e-cigarette education messages. Drug Alcohol Depend 2024; 258:111270. [PMID: 38522212 PMCID: PMC11088517 DOI: 10.1016/j.drugalcdep.2024.111270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/28/2024] [Accepted: 03/13/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Young adults' e-cigarette use is a leading public health concern. Using messages from credible sources can help improve message acceptance, yet little research has examined the role of source credibility on young adults' responses to e-cigarette education messages. METHODS We examined the impact of source on young adults' perceptions of e-cigarette education messages and e-cigarettes. In July 2022, we conducted an experimental study using an online sample of young adults (N=459, Mage=24.6) who were randomized to one of three source conditions: expert, friend, or influencer, and viewed e-cigarette education messages. We used one-way ANOVA to estimate the association between the conditions and outcomes (perceived source credibility, message trust, curiosity, use interests, perceived message effectiveness, beliefs, harm perceptions, and intentions to refrain). RESULTS The expert condition was associated with significantly higher perceived source credibility (vs. friend, influencer; p<0.001), message trust (vs. friend, influencer; p<0.001), and curiosity (vs. influencer; p's<0.05). CONCLUSIONS Public health campaigns may leverage health experts to deliver e-cigarette education messages targeting young adults to improve effectiveness of the messages.
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Affiliation(s)
- Donghee N Lee
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, Worcester, MA, USA.
| | - Jessica Liu
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Hannah Stevens
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Katherine Oduguwa
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Elise M Stevens
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, Worcester, MA, USA
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Bigwanto M, Pénzes M, Urbán R. Does sensation-seeking behavior influence the patterns of flavored e-cigarette use? A cross-sectional study among Indonesian adolescents and young adults. BMC Public Health 2024; 24:1140. [PMID: 38658887 PMCID: PMC11040837 DOI: 10.1186/s12889-024-18626-3] [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: 02/01/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The variety of available flavors in e-cigarettes may be a driver for young people to start using these products. The objectives of our study were to examine the relationship between sensation-seeking behavior and e-cigarette use, and to identify the predictors of flavor use patterns among adolescents in Indonesia. METHODS Students aged 15 to 24 years participated from randomly selected high schools and universities in Indonesia. Participants answered questions about their demographic data, e-cigarette use, conventional cigarette use, and sensation-seeking. Flavor preferences were identified from eight different flavor categories. Multivariate multinomial regression analysis was employed to predict conventional cigarette and e-cigarette use among students. A latent class analysis was conducted to determine the number of latent classes of flavor use. RESULTS One thousand six hundred high school and university students, with a mean age of 18.2 years (SD 2.19), were recruited between March and August, 2023. Conventional cigarette use in the past 30 days was higher (16.3%) compared to e-cigarette use (13.3%, p = 0.017), with approximately 8.5% of students were being dual users. Higher levels of sensation-seeking significantly increased the odds of being a current e-cigarette user (OR = 2.54, 95%CI 1.99-3.25) and a current conventional cigarette smoker (OR = 2.38, 95%CI 1.85-3.07). Three groups of flavor classes were identified: 1) primarily menthol flavor users (14%), who had a strong association with current conventional cigarette use; 2) experimenters, who mostly preferred fruit-flavored e-cigarettes (76%); and 3) the multi-flavor user group (10%), who had a higher sensation-seeking tendency. CONCLUSIONS Flavors, especially menthol and fruit flavors, attract youth, broaden the e-cigarette audience and are particularly appealing to high sensation-seekers. Banning these flavors could significantly deter e-cigarette initiation among youth.
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Affiliation(s)
- Mouhamad Bigwanto
- Doctoral School of Psychology, Eötvös Loránd University, Izabella U. 46, Budapest, 1064, Hungary.
- Institute of Psychology, Eötvös Loránd University, Izabella U. 46, Budapest, 1064, Hungary.
- Faculty of Health Sciences, Universitas Muhammadiyah Prof. Dr. HAMKA, Jl Limau II, Jakarta, 12210, Indonesia.
| | - Melinda Pénzes
- Data-Driven Health Division of the National Laboratory for Health Security, Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, H-1125, Hungary
| | - Róbert Urbán
- Doctoral School of Psychology, Eötvös Loránd University, Izabella U. 46, Budapest, 1064, Hungary
- Institute of Psychology, Eötvös Loránd University, Izabella U. 46, Budapest, 1064, Hungary
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Vassey J, Kennedy CJ, Herbert Chang HC, Smith AS, Unger JB. Scalable Surveillance of E-Cigarette Products on Instagram and TikTok Using Computer Vision. Nicotine Tob Res 2024; 26:552-560. [PMID: 37947283 PMCID: PMC11033573 DOI: 10.1093/ntr/ntad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 09/14/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Instagram and TikTok, video-based social media platforms popular among adolescents, contain tobacco-related content despite the platforms' policies prohibiting substance-related posts. Prior research identified themes in e-cigarette-related social media posts using qualitative or text-based machine learning methods. We developed an image-based computer vision model to identify e-cigarette products in social media images and videos. AIMS AND METHODS We created a data set of 6999 Instagram images labeled for 8 object classes: mod or pod devices, e-juice containers, packaging boxes, nicotine warning labels, e-juice flavors, e-cigarette brand names, and smoke clouds. We trained a DyHead object detection model using a Swin-Large backbone, evaluated the model's performance on 20 Instagram and TikTok videos, and applied the model to 14 072 e-cigarette-related promotional TikTok videos (2019-2022; 10 276 485 frames). RESULTS The model achieved the following mean average precision scores on the image test set: e-juice container: 0.89; pod device: 0.67; mod device: 0.54; packaging box: 0.84; nicotine warning label: 0.86; e-cigarette brand name: 0.71; e-juice flavor name: 0.89; and smoke cloud: 0.46. The prevalence of pod devices in promotional TikTok videos increased by 15% from 2019 to 2022. The prevalence of e-juices increased by 33% from 2021 to 2022. The prevalence of e-juice flavor names and e-cigarette brand names increased by about 100% from 2019 to 2022. CONCLUSIONS Deep learning-based object detection technology enables automated analysis of visual posts on social media. Our computer vision model can detect the presence of e-cigarettes products in images and videos, providing valuable surveillance data for tobacco regulatory science (TRS). IMPLICATIONS Prior research identified themes in e-cigarette-related social media posts using qualitative or text-based machine learning methods. We developed an image-based computer vision model to identify e-cigarette products in social media images and videos. We trained a DyHead object detection model using a Swin-Large backbone, evaluated the model's performance on 20 Instagram and TikTok videos featuring at least two e-cigarette objects, and applied the model to 14 072 e-cigarette-related promotional TikTok videos (2019-2022; 10 276 485 frames). The deep learning model can be used for automated, scalable surveillance of image- and video-based e-cigarette-related promotional content on social media, providing valuable data for TRS. Social media platforms could use computer vision to identify tobacco-related imagery and remove it promptly, which could reduce adolescents' exposure to tobacco content online.
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Affiliation(s)
- Julia Vassey
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Chris J Kennedy
- Center for Precision Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ho-Chun Herbert Chang
- Department of Quantitative Social Science, Dartmouth College, Hanover, NH, USA
- Information Sciences Institute, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Ashley S Smith
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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12
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Bigwanto M, Ramadhan FA, Wijayanto XA. Online e-cigarette promotion in Indonesia. Tob Control 2024; 33:406-409. [PMID: 36344256 DOI: 10.1136/tc-2022-057568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The decline in the global prevalence of cigarette smoking has prompted tobacco companies to expand their business by producing and marketing new nicotine-based products in various countries, including Indonesia. The study aims to assess e-cigarette promotional frequency and content on social media in Indonesia. METHODS Monitoring was conducted on Instagram in October 2021. A total of 45 Instagram influencer accounts were monitored to assess the frequency of posting and interactions from 4 to 20 October for InstaStories and from 4 to 31 October for Instagram Feeds. Content analysis was carried out on 310 posts collected from 10 randomly selected accounts from 1 to 31 October (one post per account per day) to evaluate the form, type and characteristics of the promotions. RESULTS There were a total of 2 897 327 followers across the 45 Instagram accounts. On average, the 45 accounts posted about 185 stories and 43 feed posts per day. Of the 310 feed posts analysed from 10 randomly selected accounts, 64% featured images of women; 50% highlighted or displayed the product; and 32% showed enjoyment of the product flavours. CONCLUSIONS The tobacco industry has successfully taken advantage of the e-cigarette promotion regulatory void. The Indonesian government needs to ban the promotion of these products, including those on online platforms.
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Affiliation(s)
- Mouhamad Bigwanto
- Doctoral School of Psychology. Faculty of Education and Psychology, Eotvos Lorand University, Budapest, Hungary
- Faculty of Health Sciences, University of Muhammadiyah Prof Dr Hamka, Jakarta Selatan, Indonesia
- Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
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13
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Yang Q. Understanding the Associations Between Adolescents' Exposure to E-Cigarette Information and Vaping Behavior Through the Theory of Planned Behavior. HEALTH COMMUNICATION 2024; 39:641-651. [PMID: 36823032 DOI: 10.1080/10410236.2023.2179715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Adolescents have actively looked for and passively scanned information about electronic cigarettes (e-cigarettes) from a variety of media and interpersonal sources. Despite the evidence that exposure to e-cigarette information is associated with youth's increased vaping intention, there is a paucity of scholarship that differentiates the sources where adolescents obtain e-cigarette information in their investigation, which limits our understanding of the unique association between vaping intention and e-cigarette information acquisition from specific sources. In addition, few studies have systematically examined the mechanism of the aforementioned associations. To fill the gap, an online national survey on a panel of adolescents between 13 to 17 years old was conducted. After controlling for potential confounders, several significant indirect effects were observed. Specifically, adolescents' vaping intention was negatively associated with e-cigarette information seeking from health professionals but positively with e-cigarette information exposure from family and friends, outdoors advertisements, social media, and other online channels, with the theory of planned behavior (TPB) constructs mediating these relationships. The findings not only contribute to the body of scholarship on TPB but also provide important suggestions for regulating outdoor and online e-cigarette information and designing persuasive interventions and campaigns.
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Affiliation(s)
- Qinghua Yang
- Department of Communication Studies, Bob Schieffer College of Communication, Texas Christian University
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14
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Zhou R, Xie Z, Tang Q, Li D. Social Network Analysis of e-Cigarette-Related Social Media Influencers on Twitter/X: Observational Study. JMIR Form Res 2024; 8:e53666. [PMID: 38557555 PMCID: PMC11019427 DOI: 10.2196/53666] [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: 10/14/2023] [Revised: 01/29/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND An e-cigarette uses a battery to heat a liquid that generates an aerosol for consumers to inhale. e-Cigarette use (vaping) has been associated with respiratory disease, cardiovascular disease, and cognitive functions. Recently, vaping has become increasingly popular, especially among youth and young adults. OBJECTIVE The aim of this study was to understand the social networks of Twitter (now rebranded as X) influencers related to e-cigarettes through social network analysis. METHODS Through the Twitter streaming application programming interface, we identified 3,617,766 unique Twitter accounts posting e-cigarette-related tweets from May 3, 2021, to June 10, 2022. Among these, we identified 33 e-cigarette influencers. The followers of these influencers were grouped according to whether or not they post about e-cigarettes themselves; specifically, the former group was defined as having posted at least five e-cigarette-related tweets in the past year, whereas the latter group was defined as followers that had not posted any e-cigarette-related tweets in the past 3 years. We randomly sampled 100 user accounts among each group of e-cigarette influencer followers and created corresponding social networks for each e-cigarette influencer. We compared various network measures (eg, clustering coefficient) between the networks of the two follower groups. RESULTS Major topics from e-cigarette-related tweets posted by the 33 e-cigarette influencers included advocating against vaping policy (48.0%), vaping as a method to quit smoking (28.0%), and vaping product promotion (24.0%). The follower networks of these 33 influencers showed more connections for those who also post about e-cigarettes than for followers who do not post about e-cigarettes, with significantly higher clustering coefficients for the former group (0.398 vs 0.098; P=.005). Further, networks of followers who post about e-cigarettes exhibited substantially more incoming and outgoing connections than those of followers who do not post about e-cigarettes, with significantly higher in-degree (0.273 vs 0.084; P=.02), closeness (0.452 vs 0.137; P=.04), betweenness (0.036 vs 0.008; P=.001), and out-of-degree (0.097 vs 0.014; P=.02) centrality values. The followers who post about e-cigarettes also had a significantly (P<.001) higher number of followers (n=322) than that of followers who do not post about e-cigarettes (n=201). The number of tweets in the networks of followers who post about e-cigarettes was significantly higher than that in the networks of followers who do not post about e-cigarettes (93 vs 43; P<.001). Two major topics discussed in the networks of followers who post about e-cigarettes included promoting e-cigarette products or vaping activity (55.7%) and vaping being a help for smoking cessation and harm reduction (44.3%). CONCLUSIONS Followers of e-cigarette influencers who also post about e-cigarettes have more closely connected networks than those of followers who do not themselves post about e-cigarettes. These findings provide a potentially practical intervention approach for future antivaping campaigns.
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Affiliation(s)
- Runtao Zhou
- Goergen Institute for Data Science, University of Rochester, Rochester, NY, United States
| | - Zidian Xie
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Qihang Tang
- Goergen Institute for Data Science, University of Rochester, Rochester, NY, United States
| | - Dongmei Li
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
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15
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Jancey J, Crawford G, Bowman E, Wolf K, Leaver T, Bialous S, McCausland K. Perceptions of social media harms and potential management strategies: vaping case study. BMC Public Health 2024; 24:876. [PMID: 38515083 PMCID: PMC10958968 DOI: 10.1186/s12889-024-18362-8] [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: 12/11/2023] [Accepted: 03/14/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The social media landscape is now ubiquitous in people's everyday lives. It is a space where culture, politics, economics and sociological and public health discourses occur. There is mounting evidence that e-cigarette products are being promoted and advertised on social media, a media platform particularly popular with young people. Our research aimed to understand industry professionals' perceptions of social media harms and potential management strategies using vaping as a case study. METHODS A critical realist perspective guided reflexive thematic analysis of the qualitative in depth, semi structured interviews. Data collection occurred in January and February 2023 with 13 participants working in the areas of public health, digital media, law, governance, tobacco control and advocacy. RESULTS Two superordinate themes emerged from the data: (1) Fathoming a complex system (social media) that contained the subordinate themes of Traversing Boundaries (crossing borders, crossing sectors) and Ungovernable (global and local landscapes, vested interests, self-regulation and opacity). (2) Addressing complexity (social media)- that contained the subordinate themes of Strengthening Institutions (global to local, policy and legislation, individuals and organisations); Defanging Industry (responsibility and transparency, moderation and algorithms, complaints); and Engaging Citizens (raising awareness, framing messaging). CONCLUSIONS There was consensus among participants that e-cigarette related social media content can be harmful and government action is urgently needed. There was an identified need for the development of government led national-level regulatory frameworks, with government led appropriate legislation; identification of an organisation or organisations with suitable levels of regulatory power and resources to monitor, enforce and penalise noncompliant social media companies; accompanied by increased community awareness raising of harmful social media content and improved digital literacy.
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Affiliation(s)
- Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Kent Street, Perth, WA, 6102, Australia.
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Kent Street, Perth, WA, 6102, Australia
| | - Elizabeth Bowman
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Kent Street, Perth, WA, 6102, Australia
| | - Katharina Wolf
- School of Management and Marketing, Curtin University, Kent Street, Perth, WA, 6102, Australia
| | - Tama Leaver
- School of Media, Creative Arts and Social Inquiry, Curtin University, Kent Street, Perth, WA, 6102, Australia
| | - Stella Bialous
- School of Nursing, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Kahlia McCausland
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Kent Street, Perth, WA, 6102, Australia
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16
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Buller DB, Sussman AL, Thomson CA, Kepka D, Taren D, Henry KL, Warner EL, Walkosz BJ, Woodall WG, Nuss K, Blair CK, Guest DD, Borrayo EA, Gordon JS, Hatcher J, Wetter DW, Kinsey A, Jones CF, Yung AK, Christini K, Berteletti J, Torres JA, Barraza Perez EY, Small A. #4Corners4Health Social Media Cancer Prevention Campaign for Emerging Adults: Protocol for a Randomized Stepped-Wedge Trial. JMIR Res Protoc 2024; 13:e50392. [PMID: 38386396 PMCID: PMC10921336 DOI: 10.2196/50392] [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: 06/29/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Many emerging adults (EAs) are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among EAs delivered over social media is limited. Cancer prevention information and recommendations may reach EAs more effectively over social media than in settings such as health care, schools, and workplaces, particularly for EAs residing in rural areas. OBJECTIVE This pragmatic randomized trial aims to evaluate a multirisk factor intervention using a social media campaign designed with community advisers aimed at decreasing cancer risk factors among EAs. The trial will target EAs from diverse backgrounds living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah. METHODS We will recruit a sample of EAs (n=1000) aged 18 to 26 years residing in rural counties (Rural-Urban Continuum Codes 4 to 9) in the Four Corners states from the Qualtrics' research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and human papillomavirus vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Campaign posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and EAs and focus groups with EAs. The EAs will complete assessments at baseline and at 12, 26, 39, 52, and 104 weeks after randomization. Assessments will measure 6 cancer risk behaviors, theoretical mediators, and participants' engagement with the social media campaign. RESULTS The trial is in its start-up phase. It is being led by a steering committee. Team members are working in 3 subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by EAs, and community resources available. A framework for the social media campaign with topics, format, and theoretical mediators has been created, along with protocols for campaign management. CONCLUSIONS Social media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among EAs. Because of the popularity of web-based information sources among EAs, an innovative, multirisk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors. TRIAL REGISTRATION ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50392.
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Affiliation(s)
| | - Andrew L Sussman
- University of New Mexico Comprehensive Cancer Care Center, Albuquerque, NM, United States
| | - Cynthia A Thomson
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Deanna Kepka
- College of Nursing and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Douglas Taren
- Section of Nutrition, University of Colorado Denver, Aurora, CO, United States
| | - Kimberly L Henry
- Department of Psychology, College of Natural Sciences, Colorado State University, Fort Collins, CO, United States
| | - Echo L Warner
- College of Nursing and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | | | | | - Kayla Nuss
- Klein Buendel, Golden, CO, United States
| | - Cindy K Blair
- University of New Mexico Comprehensive Cancer Care Center, Albuquerque, NM, United States
| | - Dolores D Guest
- University of New Mexico Comprehensive Cancer Care Center, Albuquerque, NM, United States
| | - Evelinn A Borrayo
- University of Colorado Cancer Center, University of Colorado Denver, Aurora, CO, United States
| | - Judith S Gordon
- College of Nursing, University of Arizona, Tucson, AZ, United States
| | | | - David W Wetter
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | | | - Christopher F Jones
- University of Colorado Cancer Center, University of Colorado Denver, Aurora, CO, United States
| | - Angela K Yung
- College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Kaila Christini
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | | | - John A Torres
- University of New Mexico Comprehensive Cancer Care Center, Albuquerque, NM, United States
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Sheth P, Mehta F, Jangid G, Anamika FNU, Singh B, Kanagala SG, Jain R. The Rising Use of E-Cigarettes: Unveiling the Health Risks and Controversies. Cardiol Rev 2024:00045415-990000000-00217. [PMID: 38385663 DOI: 10.1097/crd.0000000000000666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
The use of e-cigarettes has tremendously increased in recent times due to the widespread availability of e-cigarettes in diverse flavors, reduced cost compared to regular cigarettes, and misconception of being comparatively safe, which have led to around 2.55 million US middle and high school students smoking e-cigarettes. These devices use a nicotine-rich liquid, which is aerosolized electronically, producing vapors that may also include hazardous chemicals and heavy metals. E-cigarettes are associated with e-cigarette or vaping-associated lung injury, which presents as an acute respiratory ailment mirroring various pulmonary diseases. Additionally, it causes endothelial dysfunction, alters blood lipid profile by elevating circulating levels of low-density lipoprotein cholesterol, increases sympathetic tone, and is found to correlate with arterial stiffening, hence negatively affecting respiratory, cardiovascular, and overall health. We aim to provide a comprehensive analysis of the data on e-cigarettes and their harmful effects on health in comparison to conventional cigarette use by highlighting the pathophysiology of e-cigarette-induced adverse effects and critically analyzing the data both in favor and against its use. Our review concludes that no matter how much nicotine an e-cigarette contains, evidence shows that using it increases the risk of cardiovascular disease, albeit maybe not as much as smoking regular tobacco. Nonetheless, it is crucial to note that the long-term effects of e-cigarette usage are still not fully understood, and existing data have provided opposing viewpoints.
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Affiliation(s)
- Parth Sheth
- From the Internal Medicine, Smt. NHL Municipal Medical College, Ahmedabad, India
| | - Fena Mehta
- From the Internal Medicine, Smt. NHL Municipal Medical College, Ahmedabad, India
| | - Gurusha Jangid
- Internal Medicine, Dr. Sampurnanand Medical College, Jodhpur, India
| | - F N U Anamika
- Internal Medicine, University College of Medical Sciences, New Delhi, India
| | - Bhupinder Singh
- Internal Medicine, Government Medical College, Amritsar, Punjab, India
| | | | - Rohit Jain
- Internal Medicine, Penn State Hershey Medical Center, Hershey, PA
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18
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Vogel EA, Barrington-Trimis JL, Vassey J, Soto D, Unger JB. Young Adults' Exposure to and Engagement With Tobacco-Related Social Media Content and Subsequent Tobacco Use. Nicotine Tob Res 2024; 26:S3-S12. [PMID: 38366337 PMCID: PMC10873498 DOI: 10.1093/ntr/ntad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/18/2023] [Accepted: 06/28/2023] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Nicotine/tobacco social media content may increase young people's risk for use. This study examined prospective associations between exposure to and engagement with nicotine/tobacco-related social media content and nicotine/tobacco use among young adults. AIMS AND METHODS Young adults (N = 2080) originally recruited from Southern California high schools for a prospective cohort study reported frequency of viewing and posting nicotine/tobacco content on four social media platforms (Facebook, Instagram, Twitter, and YouTube). Participants also reported frequency of seeing nicotine/tobacco posts from friends, seeing nicotine/tobacco posts from influencers or celebrities, and liking nicotine/tobacco posts. Within subsamples of nicotine/tobacco never users (n = 794), past users (n = 897) and current users (n = 389), analyses examined associations of baseline (May-October 2020) social media content exposure and engagement with follow-up (January-June 2021) tobacco use initiation (among never users), resumption (among past users), and continuation (among current users), adjusting for sociodemographic and socioenvironmental characteristics. RESULTS Never users who saw nicotine/tobacco posts from friends (Adjusted Odds Ratio [AOR] = 2.91 [95% Confidence Interval [CI]: 1.46, 5.82], p = .002) or from celebrities or influencers (AOR = 2.77 [1.32, 5.84], p = .007) were significantly more likely to initiate nicotine/tobacco use than their peers. Among past users, posting nicotine/tobacco content at baseline was associated with use resumption (AOR = 1.77 [1.12, 2.80], p = .014). Content exposure and engagement were not associated with nicotine/tobacco use continuation among current users (p-values > .05). CONCLUSIONS Seeing nicotine/tobacco posts from friends, influencers, or celebrities was associated with greater odds of tobacco use initiation, but not resumption or continuation, 6 months later. Young adults with past nicotine/tobacco use who post about nicotine/tobacco may be at elevated risk for resuming use. IMPLICATIONS Young adults with exposure to nicotine/tobacco social media content were more likely than their peers to initiate nicotine/tobacco use 6 months later. Past nicotine/tobacco users who reported posting about nicotine/tobacco on social media at baseline were more likely than their peers to resume nicotine/tobacco use. Among young adults with current nicotine/tobacco use at baseline, social media activity did not predict odds of nicotine/tobacco use continuation at follow-up. Nicotine/tobacco content on social media should be restricted to reduce young people's chances of nicotine/tobacco use initiation or resumption.
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Affiliation(s)
- Erin A Vogel
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Julia Vassey
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
| | - Daniel Soto
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
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19
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Murthy D, Ouellette RR, Anand T, Radhakrishnan S, Mohan NC, Lee J, Kong G. Using Computer Vision to Detect E-cigarette Content in TikTok Videos. Nicotine Tob Res 2024; 26:S36-S42. [PMID: 38366342 PMCID: PMC10873490 DOI: 10.1093/ntr/ntad184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/15/2023] [Accepted: 09/27/2023] [Indexed: 02/18/2024]
Abstract
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.
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Affiliation(s)
- Dhiraj Murthy
- Moody College of Communication, University of Texas at Austin, Austin, TX, USA
| | | | - Tanvi Anand
- Cockrell School of Engineering, University of Texas at Austin, Austin, TX, USA
| | - Srijith Radhakrishnan
- Department of Information and Communication Technology, Manipal Institute of Technology, Manipal, Karnataka, India
| | - Nikhil C Mohan
- Department of Information and Communication Technology, Manipal Institute of Technology, Manipal, Karnataka, India
| | - Juhan Lee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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20
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James SA, White AH, Kahn FF, Mushtaq N, Chen S, Beebe LA. Susceptibility to e-cigarette use and associated factors in high school youth, Oklahoma Youth Tobacco Survey, 2021-2022. Front Public Health 2024; 12:1348926. [PMID: 38362222 PMCID: PMC10867248 DOI: 10.3389/fpubh.2024.1348926] [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: 12/03/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Susceptibility predicts subsequent uptake of e-cigarettes (EC) by youth. This study identified factors associated with EC susceptibility among high school students who have never used a tobacco/nicotine product. Methods The Oklahoma Youth Tobacco Survey was administered to a random sample of 36 Oklahoma High Schools during the 2021-2022 school year (n = 1,220 participating students). Associations between EC susceptibility and covariates were identified using stepwise logistic regression for weighted survey data. Results More than one third of Oklahoma high school students who had never used tobacco or nicotine products (36.4%) were susceptible, and males had higher susceptibility than females (38.8 and 33.9%, respectively). In males, EC susceptibility was associated with race (Black, American Indian, and other were less susceptible), psychological distress (aOR = 2.4, 95% CI = 1.1, 4.8), disagreement that all tobacco products are dangerous (aOR = 3.1, 95% CI = 1.2, 7.9), and perception of little/no harm from secondhand vapor (aOR = 3.4, 95% CI = 2.1, 5.3). In females, identifying as gay, lesbian, or bisexual (aOR = 2.1, 95% CI = 1.1, 3.9), poor academic performance (aOR = 4.5, 95% CI = 1.6, 12.6), psychological distress (aOR = 2.6, 95% CI = 1.2, 5.5) and interacting with EC content on social media (aOR = 5.9, 95% CI = 1.9, 18.1) were associated with EC susceptibility. Conclusion Males and females had different patterns of susceptibility to EC use. Understanding groups of adolescents most susceptible to using nicotine products can help target prevention efforts at home, in schools, and within communities.
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Affiliation(s)
- Shirley A. James
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Ashley H. White
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Fahad F. Kahn
- Oklahoma State Department of Health, Oklahoma City, OK, United States
| | - Nasir Mushtaq
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Laura A. Beebe
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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21
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Liao LL, Chang LC, Lai IJ, Lee CK. College Students' E-health Literacy, Social Media Use, and Perceptions of E-cigarettes in Taiwan. J Community Health 2024; 49:52-60. [PMID: 37420015 DOI: 10.1007/s10900-023-01255-z] [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] [Accepted: 06/27/2023] [Indexed: 07/09/2023]
Abstract
This study aimed to examine the relationship between social media use, e-health literacy, and the risk and benefit perceptions of e-cigarettes among college students in Taiwan. A cross-sectional online survey was conducted with 1,571 Taiwanese college students, which included four questionnaires to assess participants' perceptions, social media use behavior, e-health literacy, and sociodemographic factors. The data were presented in terms of means, standard deviations, and percentages. Stepwise regression was used to identify factors associated with the participants' perceptions. The study found that 75.01% of the participants were exposed to e-cigarette information on social media, with 31.26% actively searching for it and 15.95% sharing it. Participants had a high e-cigarette risk perception, indicating low benefit perception, but acceptable e-health literacy. Factors such as current e-cigarette and tobacco use, e-health literacy, academic achievement, and sex significantly predicted e-cigarette risk perception, while sharing e-cigarette related information, sex, age, academic achievement, and current e-cigarette use significantly predicted its benefit perception. Thus, implementing effective e-health literacy programs to enhance college students' e-cigarette risk perception is recommended along with a proactive approach to tackle e-cigarette advertising messages on social media, minimizing their sharing behavior to decrease their perception of associated benefits.
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Affiliation(s)
- Li-Ling Liao
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Chun Chang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - I-Ju Lai
- Department of Nutrition, I-Shou University, Kaohsiung, Taiwan
| | - Chia-Kuei Lee
- Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 70101, Taiwan.
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22
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Zheng X, Yang M, Li W, Lin HC. The mediating roles of mental health problems and racial differences in the linkage between social media use and E-cigarette use among American youth. Prev Med 2024; 179:107842. [PMID: 38169240 DOI: 10.1016/j.ypmed.2023.107842] [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] [Received: 09/17/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Social media use is shown to be linked to youth's e-cigarette use. However, less is known about the underlying mechanisms. This study examined the mediating roles of internalizing and externalizing problems in the association between youth's social media use and e-cigarette use, and the racial differences in the mediation association. METHODS The study sample included 4913 U.S. youth from the Population Assessment of Tobacco and Health Study Waves 3-5 (2015-2019). Two weighted generalized structural equation models were conducted to examine the mediation pathways between youth's social media use (Wave 3) and past-30-day e-cigarette use (Wave 5) through internalizing and externalizing problems (Wave 4), respectively. Invariance tests were conducted to examine racial group differences. RESULTS Youth with high social media use frequency were more likely to use e-cigarettes (total effect: OR = 1.20, p < 0.001 in both internalizing and externalizing models). Internalizing and externalizing problems mediated the aforementioned associations (mediation proportions: 5.05% and 5.66%, respectively). The invariance tests indicated a significant difference between White and non-White groups (both ps < 0.001), where a larger proportion of mediation was found in the non-White group (12.22% for internalizing and 11.99% for externalizing) compared to their White counterparts (2.46% for internalizing and 3.17% for externalizing). CONCLUSIONS Mental health problems following social media use served as a risk factor for e-cigarette use among youth. Interventions aiming to improve youth's mental health could in turn temper e-cigarette use among youth social media users, and implementing tailored interventions in response to racial differences is warranted.
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Affiliation(s)
- Xia Zheng
- School of Communication and Journalism, Stony Brook University, NY, United States of America
| | - Meng Yang
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States of America
| | - Wenbo Li
- School of Communication and Journalism, Stony Brook University, NY, United States of America
| | - Hsien-Chang Lin
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States of America.
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23
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Vogel EA, Unger JB, Vassey J, Barrington-Trimis JL. Effects of a nicotine warning label and vaping cessation resources on young adults' perceptions of pro-vaping instagram influencer posts. Addict Behav 2024; 149:107888. [PMID: 37857044 PMCID: PMC10841614 DOI: 10.1016/j.addbeh.2023.107888] [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: 08/18/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Exposure to social media content promoting e-cigarette use ("vaping") is associated with subsequent tobacco use among young adults. Adding features to pro-vaping Instagram influencer posts, such as a nicotine warning label and vaping cessation resources, could help counteract posts' negative influence. METHODS Young adults (N = 2,179; Mage = 22.6 [SD = 0.4]; 53.0 % cisgender women, 45.1 % Hispanic) completed an online experiment in 2021-2022 through an ongoing prospective cohort study. Participants viewed three simulated pro-vaping Instagram influencer posts in a four-group, between-subjects design. Post features differed by experimental condition: "label-only" (nicotine warning label on post), "link-only" (link to vaping cessation resources under post), "L&L" (label and link), or "control" (neither). Participants rated each influencer's traits (honest, trustworthy, informed, smart, attractive, popular; 0-100 %). After viewing all three posts, participants reported use intentions, susceptibility, positive and negative expectancies, and harm perceptions around the fictitious advertised vaping product. Past-month vapers additionally reported their desire and self-efficacy for quitting. RESULTS L&L (versus control and link-only) participants viewed influencers as more honest, trustworthy, and informed. L&L (versus control) participants had lower odds of susceptibility to using the advertised product, lower positive expectancies, and greater negative expectancies. The label and link did not significantly affect participants' intentions to use the product, perceived harm of the product, or desire or self-efficacy for quitting vaping. CONCLUSIONS Providing a nicotine warning label and link to vaping cessation resources on influencers' Instagram posts may have the unintended effect of increasing positive perceptions of the influencer. However, they may reduce susceptibility to product use.
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Affiliation(s)
- Erin A Vogel
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, 1845 N. Soto St., Los Angeles, CA 90089, USA; Institute for Addiction Sciences, University of Southern California, 1845 N. Soto St., Los Angeles, CA 90089, USA.
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, 1845 N. Soto St., Los Angeles, CA 90089, USA; Institute for Addiction Sciences, University of Southern California, 1845 N. Soto St., Los Angeles, CA 90089, USA; Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave., Los Angeles, CA 90033, USA
| | - Julia Vassey
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, 1845 N. Soto St., Los Angeles, CA 90089, USA
| | - Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, 1845 N. Soto St., Los Angeles, CA 90089, USA; Institute for Addiction Sciences, University of Southern California, 1845 N. Soto St., Los Angeles, CA 90089, USA; Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave., Los Angeles, CA 90033, USA
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24
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Shroff SM, Sreeramareddy CT. Marketing claims, promotional strategies, and product information on Malaysian e-cigarette retailer websites-a content analysis. Subst Abuse Treat Prev Policy 2024; 19:11. [PMID: 38273314 PMCID: PMC10809498 DOI: 10.1186/s13011-024-00592-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Marketing and sales of e-cigarettes are unregulated in Malaysia. We analyzed content displayed on e-cigarette retailer websites to identify marketing claims, promotional strategies, and product details in the year 2022. METHODS We analyzed 30 Malaysia-based retailer websites using a mixed methods approach. Data were extracted as the frequency of occurrences of marketing claims, presence of regulatory information, product types, and flavors of e-juice as per a predefined codebook based on published literature. We also extracted textual details published on the websites about marketing claims, and slogans. RESULTS Most retailer websites provided contact information and physical store addresses (83%) but only half had 'click through' age verification (57%) that seldom needed any identification proof for age (3%). Marketing claims were related to health (47%), smoking cessation (37%), and modernity/trend (37%) and none had health warnings. Promotional strategies were discounts (80%). starter kits (57%) and email subscriptions (53%). Product types displayed were rechargeable (97%) and disposable (87%) devices and e-liquids (90%) of an array of flavors (> 100). Nicotine presence, its concentration, and "nicotine is an addictive chemical" were displayed in 93%, 53%, and 23% of websites respectively. CONCLUSION Surveillance of content displayed online on e-cigarette retailer websites and regulation of online marketing and sales should be implemented by the Ministry of Health, Malaysia. Such measures are needed to prevent access to, and initiation of e-cigarette use among the youth and adults who do not smoke.
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Affiliation(s)
- Sameeha Misriya Shroff
- School of Postgraduate Studies, International Medical University, Jalan Jalil Perkasa 19, Kuala Lumpur, 57000, Malaysia
| | - Chandrashekhar T Sreeramareddy
- Division of Community Medicine and Public Health, International Medical University, Jalan Jalil Perkasa 19, Kuala Lumpur 57000, Malaysia.
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25
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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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26
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Jancey J, Carey RN, Freeman B, Leaver T, Wolf K, Bromberg M, Chai K, Bialous S, Adams P, Mcleod M, McCausland K. E-cigarettes on Instagram: Exploring vape content via an Australian vaping influencer. Tob Induc Dis 2024; 22:TID-22-19. [PMID: 38250632 PMCID: PMC10798224 DOI: 10.18332/tid/175619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Mounting evidence suggests that electronic cigarettes (e-cigarettes) are extensively promoted and marketed using social media, including through user-generated content and social media influencers. This study explores how e-cigarettes are being promoted on Instagram, using a case-study approach, and the extent to which Meta's Restricted Goods and Services Policy (Meta's policy) is being applied and enforced. METHODS We identified the accounts followed by an Australian Instagram influencer who primarily posts e-cigarette-related content. The main foci of these 855 accounts were coded and 369 vaping-focused accounts were identified. These vaping-focused accounts were then further coded by two trained coders. RESULTS All (n=369; 100.0%) of the vape content posted by these accounts was positive in sentiment. One-third of the vape accounts (n=127; 34.4%) had a shared focus, indicating that vape content may permeate into other online communities through shared interests. A total of 64 accounts (17.3%) potentially violated Meta's policy by attempting to purchase, sell, raffle or gift e-cigarette products. CONCLUSIONS The findings of this study suggest that pro-vaping information is available and accessible on Instagram. Much of the content identified in this study promoted the purchase or gifting of e-cigarette products and potentially violates Meta's policy. Greater regulation and/or stronger enforcement of e-cigarette content on social media platforms such as Instagram is necessary to prevent the ongoing promotion of these harmful products.
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Affiliation(s)
- Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - Renee N. Carey
- School of Population Health, Curtin University, Bentley, Australia
| | - Becky Freeman
- School of Public Health, University of Sydney, Sydney, Australia
| | - Tama Leaver
- Internet Studies, School of Media, Creative Arts and Social Inquiry, Curtin University, Bentley, Australia
| | - Katharina Wolf
- School of Management and Marketing, Curtin University, Bentley, Australia
| | - Marilyn Bromberg
- Law School, The University of Western Australia, Crawley, Australia
| | - Kevin Chai
- School of Population Health, Curtin University, Bentley, Australia
| | - Stella Bialous
- School of Nursing, University of California, San Francisco, United States
| | - Phoebe Adams
- Collaboration for Evidence, Research and Impact in Public Health, Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - Meghan Mcleod
- Collaboration for Evidence, Research and Impact in Public Health, Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - Kahlia McCausland
- Collaboration for Evidence, Research and Impact in Public Health, Faculty of Health Sciences, Curtin University, Bentley, Australia
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27
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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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28
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Powell J, Pring T. The impact of social media influencers on health outcomes: Systematic review. Soc Sci Med 2024; 340:116472. [PMID: 38070305 DOI: 10.1016/j.socscimed.2023.116472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/17/2023] [Accepted: 11/25/2023] [Indexed: 01/23/2024]
Abstract
A fast emerging area of public health interest is the potential role of social media influencers in spreading health information and affecting health behaviour. The aim of this research was to systematically synthesise evidence on the impact of social media influencers on health outcomes. A systematic search of six databases (Medline, Embase, PsycINFO, CINAHL, Science Citation Index and Sociology Collection) was conducted in October 2021, with an update search in January 2023. Two reviewers independently screened titles and abstracts. We included interventional study designs which examined the effect of social media influencer as the primary or only exposure on a quantified health outcome. We used narrative synthesis to summarise the characteristics and main findings of studies within each of four main topic areas. We assessed quality using a critical appraisal checklist for quasi-experimental studies. We identified twelve studies across four areas that met the inclusion criteria: children's dietary behaviour (n = 5), body image dissatisfaction (n = 4), influenza and COVID-19 (n = 2), and social comparison and anxiety (n = 1). Influencer marketing of unhealthy foods had a statistically significant effect on increasing children's immediate energy intake, but no effect was found for influencer promotion of vegetables. When an unhealthy food is marketed by an influencer of unhealthy appearance, this led to an increased preference for healthy snacks. Exposure to idealised influencer body imagery had statistically significant negative impacts on body image and mood. Anxiety caused by viewing idealised portrayals of motherhood was the same whether or not the portrayal was by an influencer. Public health campaigns harnessing influencers to promote hygiene habits in the context of COVID-19 and influenza showed some positive changes in health behaviours. Most of the published studies are of poor methodological quality with poor generalisability and statistical weaknesses. We conclude that social media influencers have both negative and positive impacts on health outcomes, with negative impacts seen consistently in studies of body image dissatisfaction. Further research is needed to harness the potential positive health impact of social media influencers, while mitigating against harmful effects.
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Affiliation(s)
- John Powell
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK.
| | - Tabitha Pring
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK
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29
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Mead-Morse EL, Delnevo CD, Singh B, Wackowski OA. Characteristics of Cheyenne little filtered cigar Instagram ads, 2019-2020. Tob Control 2023; 33:131-134. [PMID: 35728933 PMCID: PMC9768085 DOI: 10.1136/tobaccocontrol-2022-057336] [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: 02/11/2022] [Accepted: 06/08/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Little is known about little filtered cigar (LFC) marketing on social media. We examined the characteristics of Instagram posts by Cheyenne-a popular LFC brand-from 2019 to 2020. METHODS We conducted a content analysis of 323 images posted in 2019 and 2020. Descriptive statistics were examined, and χ2 and Fisher's exact tests were used to test differences by year. RESULTS Most posts (76.0%) showed ≥1 pack and/or LFC stick, which look highly similar to cigarette packs and sticks. The pack was often flavoured (62.2%). Images of lit LFC sticks increased from 2019 (12.2%) to 2020 (26.7%, p=0.005). Warning labels were present on the ad in 79.9% of posts, but always at the bottom, and used the same single warning statement that they are not a safe alternative to cigarettes. The depiction of people nearly doubled from 2019 (18.1%) to 2020 (34.8%, p=0.001), and women (50.6%) were more commonly depicted than men (32.1%). Popular depictions and themes included the outdoors (57.6%) and seasonal imagery (36.2%) among others. DISCUSSION Cheyenne actively used Instagram to market its product and grow its brand. Posts seemed designed to promote the similarity of their LFC to cigarettes, through depictions of cig-a-like packs/sticks. Although warning labels were prevalent on Cheyenne Instagram posts, the warnings were not compliant with FDA warning guidelines and might have been counterproductive by emphasising their viability as cigarette alternatives rather than their dangerous health effects. Future surveillance is needed, and regulation of LFC advertising on social media may be warranted.
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Affiliation(s)
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Binu Singh
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Olivia A Wackowski
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
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30
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Sun T, Lim CCW, Rutherford BN, Johnson B, Connor J, Gartner CE, Hall WD, Leung J, Chan G. Changes in patterns of youth multiple tobacco and/or e-cigarette product use in the US between 2014 and 2020: a multiple-group latent class analysis. Tob Control 2023; 33:21-29. [PMID: 35667834 DOI: 10.1136/tobaccocontrol-2022-057266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/23/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Multiple tobacco and e-cigarette product (MTEP) use, the concurrent use of two or more different types of tobacco and/or e-cigarettes products, is common among young people in the US. Changes in patterns of MTEP use among US youth between 2014 and 2020 were identified and the determinants of MTEP use were examined. METHODS Four years of repeated cross-sectional data from the US National Youth Tobacco Survey of middle and high school students from grade 6 to 12 (Ntotal=77 402). Multigroup latent class analysis (LCA) was applied to the data series to allow for simultaneous identification of MTEP use patterns between 2014 and 2020. Logistic regression was used to predict class membership on demographic and tobacco-related variables. FINDINGS Over the 7-year period, LCA identified three patterns: minimal/non-users (MNU: ~89.8%), mostly occasional e-cigarette and cigarette users (MOEC: ~9%) and polytobacco users (POLY: ~1.2%). From 2014 to 2020, MNU increased from 86.4% to 92% (p<0.05), while MOEC and POLY decreased from 11.2% to 7.9% and from 2.4% to 0.1%, respectively. The probability of regular e-cigarette use increased from 0 to 2.3% among MNU, 6% to 31.9% among MOEC and 29.6% to 67.6% among POLY (p<0.05). In binomial logistic regression, being male, in high school, non-heterosexual, living with someone who uses tobacco at home, having cognitive difficulties, having lower perceptions of tobacco's danger and exposure to tobacco marketing were associated with greater odds of MOEC and POLY than MNU. CONCLUSIONS There was an increase in regular e-cigarette use in all three classes, but a corresponding decrease in the proportion of MTEP use. Public health interventions to discourage uptake of e-cigarettes, such as tighter restrictions on marketing to minors, are warranted and there is a need to consider disparities in the determinants of MTEP use.
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Affiliation(s)
- Tianze Sun
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, Herston, Queensland, Australia
| | - Carmen C W Lim
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, Herston, Queensland, Australia
| | - Brienna N Rutherford
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Benjamin Johnson
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Jason Connor
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Coral E Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, Herston, Queensland, Australia
| | - Wayne D Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Gary Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
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Kulak JA, Voit HE, Balfour CA, Homish GG. College health providers' knowledge and confidence in addressing students' vaping: Evidence from a pilot study in New York State. PEC INNOVATION 2023; 2:100123. [PMID: 37214494 PMCID: PMC10194164 DOI: 10.1016/j.pecinn.2023.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 12/21/2022] [Accepted: 01/16/2023] [Indexed: 05/24/2023]
Abstract
Objective This study examines the knowledge and confidence of college healthcare providers in discussing vaping with their college student populations. Methods This is a mixed-methods descriptive study using a sequential-explanatory approach, consisting of a cross-sectional, online survey followed by qualitative interviews. Survey data was collected from 50 college health providers located at 26 colleges in the 64-campus State University of New York system. Targeted semi-structured interviews (N = 11) were conducted by telephone with providers who completed the survey. Results Despite high reported levels of knowledge and confidence, few providers had participated in educational activities relative to vaping. There was evidence of misinformation about e-cigarettes, and they did not know what product (nicotine/cannabis) students typically vape. Conclusions Findings indicate a potential disconnect between providers' perceived and actual knowledge of college student vaping and demonstrate areas of opportunity to assist college health providers in comprehensively addressing vaping with their college student populations. Innovation College health providers played a key role in lowering rates of combustible cigarette smoking, but little is known about how they are now are communicating with college students about e-cigarette and cannabis vaping. This paper examines college health providers' knowledge, confidence, and training needs relative to vaping communications.
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Affiliation(s)
- Jessica A. Kulak
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - Hannah E. Voit
- Department of Health, Nutrition, and Dietetics, Buffalo State College, Buffalo, NY, USA
| | - Cierra A. Balfour
- Department of Health, Nutrition, and Dietetics, Buffalo State College, Buffalo, NY, USA
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
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Kong G, Schott AS, Lee J, Dashtian H, Murthy D. Understanding e-cigarette content and promotion on YouTube through machine learning. Tob Control 2023; 32:739-746. [PMID: 35504690 PMCID: PMC9630169 DOI: 10.1136/tobaccocontrol-2021-057243] [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: 12/27/2021] [Accepted: 04/19/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION YouTube is a popular social media used by youth and has electronic cigarette (e-cigarette) content. We used machine learning to identify the content of e-cigarette videos, featured e-cigarette products, video uploaders, and marketing and sales of e-cigarette products. METHODS We identified e-cigarette content using 18 search terms (eg, e-cig) using fictitious youth viewer profiles and predicted four models using the metadata as the input to supervised machine learning: (1) video themes, (2) featured e-cigarette products, (3) channel type (ie, video uploaders) and (4) discount/sales. We assessed the association between engagement data and the four models. RESULTS 3830 English videos were included in the supervised machine learning. The most common video theme was 'product review' (48.9%), followed by 'instruction' (eg, 'how to' use/modify e-cigarettes; 17.3%); diverse e-cigarette products were featured; 'vape enthusiasts' most frequently posted e-cigarette videos (54.0%), followed by retailers (20.3%); 43.2% of videos had discount/sales of e-cigarettes; and the most common sales strategy was external links for purchasing (34.1%). 'Vape trick' was the least common theme but had the highest engagement (eg, >2 million views). 'Cannabis' (53.9%) and 'instruction' (49.9%) themes were more likely to have external links for purchasing (p<0.001). The four models achieved an F1 score (a measure of model accuracy) of up to 0.87. DISCUSSION Our findings indicate that on YouTube videos accessible to youth, a variety of e-cigarette products are featured through diverse videos themes, with discount/sales. The findings highlight the need to regulate the promotion of e-cigarettes on social media platforms.
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Affiliation(s)
- Grace Kong
- Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Juhan Lee
- Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Hassan Dashtian
- The School of Journalism, The University of Texas at Austin, Austin, Texas, USA
| | - Dhiraj Murthy
- The School of Journalism, The University of Texas at Austin, Austin, Texas, USA
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Roh T, Uyamasi K, Aggarwal A, Obeng A, Carrillo G. Association between e-cigarette use and asthma among US adolescents: Youth Risk Behavior Surveillance System 2015-2019. Prev Med 2023; 175:107695. [PMID: 37666307 DOI: 10.1016/j.ypmed.2023.107695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Previous studies have suggested that e-cigarette use, which has increased rapidly among US adolescents, may cause respiratory distress. This cross-sectional study aimed to investigate the factors associated with e-cigarette use and the relationship between e-cigarette use and asthma among US adolescents. METHODS Data from the Youth Risk Behavior Surveillance System between 2015 and 2019 were analyzed, and multivariable logistic regression was used to identify demographic and behavioral factors associated with e-cigarette use. Stratified analyses were conducted to assess the relationship between e-cigarette use and asthma among adolescents by previous combustible product use. RESULTS This study found that Hispanic adolescents had lower odds of e-cigarette use than White adolescents in Texas, with factors such as age, substance use, and depression being associated with use. In the US, male gender, previous combustible and substance use, and depression were associated with higher odds of ever using e-cigarettes, while current use was associated with several factors including age and White race. E-cigarette use was significantly associated with asthma among adolescents who have never used combustible products in both Texas and the entire US after adjusting for covariates (OR 1.32, 95% CI 1.06-1.66 and OR 1.18, 95% CI 1.02-1.37, respectively). CONCLUSION The findings from this study can be used to inform public health strategies and policies aimed at reducing e-cigarette use and its associated health risks among adolescents.
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Affiliation(s)
- Taehyun Roh
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX 77843, USA
| | - Kido Uyamasi
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX 77843, USA
| | - Anisha Aggarwal
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX 77843, USA
| | - Alexander Obeng
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA
| | - Genny Carrillo
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA.
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Litt DM, Zhou Z, Fairlie AM, Waldron KA, Geusens F, Lewis MA. Experimental Test of Abstaining-and-Drinking Social Media Content on Adolescent and Young Adult Social Norms and Alcohol Use. J Stud Alcohol Drugs 2023; 84:700-709. [PMID: 37306372 PMCID: PMC10600970 DOI: 10.15288/jsad.23-00061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE Experimental research has demonstrated that when alcohol-related content is viewed on social media, adolescents and young adults tend to have favorable attitudes toward alcohol use. However, limited research focuses on social media norms for abstaining from alcohol use. The current study examined the role of descriptive and injunctive alcohol-abstaining-and-drinking norms via experimentally manipulated social media profiles. Experimental effects on descriptive and injunctive normative perceptions and subsequent behavior were tested. METHOD Participants (N = 306; ages 15-20 years) were recruited from the Seattle metropolitan area to complete a baseline survey and view researcher-fabricated social media profiles. Using stratified random assignment (birth sex and age), participants were randomized into one of three conditions: (a) alcohol abstaining and drinking, (b) alcohol abstaining, and (c) attention control. RESULTS The alcohol-abstaining-and-drinking condition reported greater drinking descriptive norms compared with participants in either the alcohol-abstaining or the attention-control conditions at post-experiment and 1-month follow-up. The alcohol-abstaining-and-drinking condition reported lower abstaining descriptive norms (i.e., perceiving fewer peers abstain) compared with those in the alcohol-abstaining condition at post-experiment and lower abstaining injunctive norms compared with those in the attention-control condition at 1-month follow-up. CONCLUSIONS Exposure to social media profiles containing both alcohol-drinking and alcohol-abstaining messages was respectively associated with individuals perceiving that peers were consuming alcohol more often and that fewer peers were abstaining. The present findings are consistent with prior experimental research that indicates alcohol displays on social media are associated with riskier drinking cognitions.
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Affiliation(s)
- Dana M. Litt
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Zhengyang Zhou
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Anne M. Fairlie
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Katja A. Waldron
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania
| | - Femke Geusens
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Leuven School for Mass Communication Research, KU Leuven, Leuven, Belgium
| | - Melissa A. Lewis
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
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Yaugher AC, Pay CC, Hawks J, Meier CL. Evaluating a Multicomponent e-Cigarette Prevention Program in the Rural Northwest: Teacher and Parent/Guardian Program Outcomes. J Sch Nurs 2023:10598405231198020. [PMID: 37644848 DOI: 10.1177/10598405231198020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
There are effective prevention strategies to combat increasing rates of youth e-cigarette use. This study assessed the outcomes of an e-cigarette prevention program with teachers and parents/guardians across a three-county rural area. Researchers assessed teachers' and parent/guardians' increased knowledge and confidence in implementing vape prevention after receiving evidence-based trainings. Pre- and post-surveys demonstrated that teachers had a statistically significant increase in knowledge gain across all eight vape-specific domains assessed as expected. The parent/guardian pre- and post-survey results also show that knowledge and confidence increased significantly across seven domains. Findings suggest that multicomponent e-cigarette education and prevention programs better prepare teachers and parents/guardians to intervene with youth e-cigarette use and initiation, including being more likely to talk to youth about the risks of tobacco and vaping. Recommendations for school nurses are discussed and include educating youth, families, and staff for positive impacts.
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Affiliation(s)
- Ashley C Yaugher
- Utah State University, Cooperative Extension in Carbon, Emery, and Grand Counties, Logan, UT, USA
| | - Christina C Pay
- Utah State University, Cooperative Extension in Carbon, Emery, and Grand Counties, Logan, UT, USA
| | - Jenna Hawks
- Utah State University, Cooperative Extension in Carbon, Emery, and Grand Counties, Logan, UT, USA
| | - Cristian L Meier
- Utah State University, Cooperative Extension in Carbon, Emery, and Grand Counties, Logan, UT, USA
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Pederson LL, Koval JJ, Vingilis E. E-cigarette use by Ontario public elementary school and secondary school students: Has the use among sociodemographic groups changed from 2017 to 2019? Prev Med Rep 2023; 34:102257. [PMID: 37273527 PMCID: PMC10236451 DOI: 10.1016/j.pmedr.2023.102257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 03/27/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023] Open
Abstract
This project examined e-cigarette use among Elementary School (ES) (grades 7 and 8) and Secondary School (SS) (grades 9-12) students in Ontario, Canada, for 2017 and 2019 and relationships with sociodemographic variables and traditional cigarette use. The data came from the Ontario Student Drug Use and Health Survey OSDUHS (2017, 2019). Socio-demographics included grade, school performance, sex, race, years in Canada, living arrangements and language spoken at home. E-cigarette use and cigarette smoking were any past year use. For 2017, there are a greater percentage of ES males than females who used e-cigarettes, older students, those living in more than one home and those smoking cigarettes. For SS students a greater percentage for those of older age, higher grades, living in Canada all their lives, using only English language at home, self-identified as white, with lower school performance, those with multiple household living arrangements and who reported smoking traditional cigarettes reported using e-cigarettes. Use was lower among females in 2017 (OR = 0.63, 95% CI = 0.46, 0.86, p = 0.002), but by 2019 use was higher among females, which resulted in a non-significant difference between males and females (OR = 0.91, 95% CI = 0.77, 1.09). Greater use of e-cigarettes was found among students who smoked traditional cigarettes compared to those who did not smoke in both years. Monitoring the trends, patterns and trajectories of use and variables related to use needs to be continued which may help inform the development of further legislative and educational measures.
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Affiliation(s)
- Linda L. Pederson
- Department of Epidemiology and Biostatistics Department of Family Medicine The Western Centre for Family Medicine and Public, Health University of Western University, 1839 Aldersbrook Road, London, Ontario N6G 3S3, Canada
| | - John J. Koval
- Department of Epidemiology and Biostatistics The Western Centre for Family Medicine and Public, Health University of Western Ontario London Ontario, N6G 2M1, Canada
| | - Evelyn Vingilis
- Department of Family Medicine The Western Centre for Public Health and Family Medicine University of Western Ontario London, ON N6G 2M1, Canada
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Heinly A, Walley S. The nicotine and tobacco epidemic among adolescents: new products are addicting our youth. Curr Opin Pediatr 2023; 35:513-521. [PMID: 37335268 DOI: 10.1097/mop.0000000000001271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
PURPOSE OF REVIEW New nicotine and tobacco products such as electronic cigarettes and oral nicotine products have increased in use and threaten to addict a new generation of youth. This review summarizes current literature on nicotine and tobacco products used by youth, epidemiology, health effects, prevention and treatment of nicotine dependence, and current policies and regulations. RECENT FINDINGS Electronic cigarettes and oral nicotine products are popular among youth, attracting adolescents through exposure to deceptive marketing and fruit, candy and dessert flavors. Electronic cigarettes and oral nicotine product use can lead to nicotine addiction and is associated with respiratory, cardiovascular, and oral health problems, although long-term health effects are not fully known. The Food and Drug Administration (FDA) has authority to regulate nicotine and tobacco products; however, thousands of unregulated and unauthorized products remain on the market. SUMMARY Millions of adolescents continue to use nicotine and tobacco products, which puts them at risk for health problems, including nicotine addiction. Pediatric providers can provide prevention messages, screen youth for tobacco and nicotine use, and offer appropriate treatment options. Regulation of tobacco and nicotine products by the FDA is critical to reverse this public health epidemic of youth nicotine and tobacco use.
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Affiliation(s)
- Allison Heinly
- Hasbro Children's Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Susan Walley
- Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Keyes KM, Joseph V, Kaur N, Kreski NT, Chen Q, Martins SS, Hasin D, Olfson M, Mauro PM. Adolescent simultaneous use of alcohol and marijuana by trends in cigarette and nicotine vaping from 2000 to 2020. Drug Alcohol Depend 2023; 249:109948. [PMID: 37270934 PMCID: PMC10348405 DOI: 10.1016/j.drugalcdep.2023.109948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/25/2023] [Accepted: 05/24/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Simultaneous alcohol and marijuana (SAM) use is associated with adverse consequences for youth. While SAM use is overall declining among youth, prior studies indicate increasing marijuana use among US adolescents who ever used cigarettes, suggesting possible moderation of the alcohol-marijuana relationship by cigarette use. METHODS We included 43,845 12-th grade students participating in Monitoring the Future data (2000-2020). A 5-level alcohol/marijuana measure was used, including past-year SAM, alcohol-only, marijuana-only, non-simultaneous alcohol and marijuana, or no use. Multinomial logistic regressions estimated associations between time periods (categorized based on sample size: 2000-2005, 2006-2009, 2010-2014, 2015-2020) and the 5-level alcohol/marijuana measure. Models adjusted for sex, race, parental education and survey mode and included interactions of time periods and lifetime cigarette or vaped nicotine use. RESULTS While overall SAM among 12th graders decreased from 23.65% to 18.31% between 2000 and 2020, SAM increased among students who never used cigarettes or vaped nicotine (from 5.42% to 7.03%). Among students who ever used cigarettes or vaped nicotine, SAM increased from 39.2% in 2000-2005-44.1% in 2010-2014 then declined to 37.8% in 2015-2020. Adjusted models controlling for demographics indicated that among students with no lifetime cigarette or vaped nicotine use, students in 2015-2020 had 1.40 (95% C.I. 1.15-1.71) times the odds of SAM, and 5.43 (95% C.I. 3.63-8.12) times the odds of marijuana-only (i.e., no alcohol use) compared to students who used neither in 2000-2005. Alcohol-only declined over time in both students who ever and never used cigarettes or nicotine vape products. CONCLUSION Paradoxically, while SAM declined in the overall adolescent US population, the prevalence of SAM increased among students who have never smoked cigarettes or vaped nicotine. This effect arises because of a substantial decline in the prevalence of cigarette smoking; smoking is a risk factor for SAM, and fewer students smoke. Increases in vaping are offsetting these changes, however. Preventing adolescent use of cigarettes and nicotine vaped products could have extended benefits for other substance use, including SAM.
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Affiliation(s)
- Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Victoria Joseph
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Navdep Kaur
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Noah T Kreski
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Qixuan Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Deborah Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, USA
| | - Mark Olfson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, USA
| | - Pia M Mauro
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Vassey J, Valente T, Barker J, Stanton C, Li D, Laestadius L, Cruz TB, Unger JB. E-cigarette brands and social media influencers on Instagram: a social network analysis. Tob Control 2023; 32:e184-e191. [PMID: 35131947 PMCID: PMC9473311 DOI: 10.1136/tobaccocontrol-2021-057053] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/22/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Exposure to visual posts featuring e-cigarette products on social media is associated with increased e-cigarette use among US adolescents. Instagram is the largest source of e-cigarette social media marketing, where influencers-for example, bloggers, brand ambassadors-post promotional materials. This study analysed the network of e-cigarette brands and influencers on Instagram, characterising the most central players in e-cigarette social media marketing. METHODS We tracked influencers with public profiles on Instagram who posted promotional e-cigarette content in 2020, had over 1000 followers and high user engagement rate (ratio of likes and comments to followers) of 1%-25% per post. By conducting a social network analysis, we identified the most central (highly involved in promotional activities) influencers and e-cigarette brands. The number of the influencers' followers aged 13-17 years old and the age verification practices restricting youth access were also assessed. RESULTS There is a highly interconnected network of engaging e-cigarette influencers (n=55) worldwide who collaborated with over 600 e-cigarette brands in 2020. The Asian and US influencers had five to six times more teenage followers compared with the European influencers. 75% of the influencers did not restrict youth access to their promotional content on Instagram. The brands Voopotech, Innokin, Geekvape, Lost Vape, Smok and Vaporesso collaborated with the largest number of influencers (mean n=20). CONCLUSIONS It is important to understand associations among influencers and e-cigarette use behaviours, especially youth, to inform effective public health communication and potential policies that could regulate social media marketing sponsored by e-cigarette companies.
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Affiliation(s)
- Julia Vassey
- Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Tom Valente
- Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Joshua Barker
- Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Cassandra Stanton
- Behavioral Health and Health Policy Practice, Westat, Rockville, Maryland, USA
| | - Dongmei Li
- Clinical and Translational Science Institute, University of Rochester, Rochester, New York, USA
| | - Linnea Laestadius
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Tess Boley Cruz
- Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Jennifer B Unger
- Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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Zhao S, Li Z, Zhang L, Yu Z, Zhao X, Li Y, Zhu J. The characteristics and risk factors of e-cigarette use among adolescents in Shanghai: A case-control study. Tob Induc Dis 2023; 21:83. [PMID: 37342865 PMCID: PMC10277906 DOI: 10.18332/tid/166131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/26/2023] [Accepted: 05/12/2023] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION This study was conducted to explore the characteristics and risk factors of e-cigarette use in adolescents, aiming for tobacco control and reducing e-cigarette use in this population. METHODS Using 1:1 matching, 88 students from three vocational high schools in Shanghai were recruited to conduct a case (using e-cigarettes) - control (not using e-cigarettes) study. Group interviews and questionnaire surveys were used for this qualitative and quantitative mixed-methods study. The keywords were extracted from the interview data and analyzed by the Colaizzi seven-step method. RESULTS The characteristics of adolescents' use of e-cigarettes include young age at first use, consumption of a large amount, as well as smoking in discrete locations in order to hide from adults. The reasons for using e-cigarettes include curiosity and wanting to replace traditional cigarettes. The risk factors of using e-cigarettes include insufficient understanding of the harm of e-cigarettes at the individual level (The positive outcome expectancy points: Z= -3.746, p<0.001; The negative outcome expectancy points: Z= -3.882, p<0.001), peer influence at the interpersonal level (χ2=6.510, p<0.01), and the influence of social and environmental factors such as e-cigarette sales in the stores and WeChat Moments (p<0.05 for all associations). CONCLUSIONS Having friends who use e-cigarettes, curiosity and sales exposure about e-cigarettes are important factors affecting the use of e-cigarettes by adolescents. It is necessary to strengthen the publicity of the potential hazards of e-cigarettes and to reduce overall usage by improving relevant laws and regulations.
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Affiliation(s)
- Suizi Zhao
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Ziyan Li
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Lulu Zhang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiping Yu
- Department of Nutrition and Dietetics, University of North Florida, Florida, United States
| | - Xixuan Zhao
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Li
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Jingfen Zhu
- Center for Health Technology Assessment, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
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Liu J, Lee DN, Stevens EM. Characteristics Associated with Young Adults' Intentions to Engage with Anti-Vaping Instagram Posts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6054. [PMID: 37297658 PMCID: PMC10252522 DOI: 10.3390/ijerph20116054] [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: 01/27/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to identify behavioral and sociodemographic factors associated with intentions to engage with anti-vaping Instagram posts among a young adult population. This study proposes the following research questions: (1) Does e-cigarette use status influence intentions to engage with anti-vaping Instagram posts?, and (2) How are e-cigarette use and social media use associated? We recruited a convenience sample of young adults (N = 459; aged 18-30 years) in July of 2022 into an online experimental study from Prolific. Participants saw five image-based Instagram posts about the health harms of using e-cigarettes. Participants were then asked about their intentions to engage ("Comment on", "Reshare", "DM/Send this to a friend", "Like", and/or "Take a screenshot of") with the posts. We used logistic regression to run adjusted models for each engagement outcome, which included fixed effects for sociodemographics, tobacco use, and social media/internet use. For the sum of the engagement outcome, we used Poisson regression. Total number of social media sites used was associated with intentions to "Like" the posts (p = 0.025) and the overall engagement score (p = 0.019), respectively. Daily internet use was associated with intentions to "Comment on" (p = 0.016) and "Like" (p = 0.019) the posts. Young adults who reported past 30-day e-cigarette use had higher odds of using Twitter (p = 0.013) and TikTok (p < 0.001), and a higher total number of social media sites used (p = 0.046), compared to young adults who reported never use e-cigarettes. The initial evidence from our exploratory research using a convenience sample suggests that social media campaigns about the harms of e-cigarette use may be an effective way to engage younger audiences, a generation that frequents social media. Efforts to disseminate social media campaigns should consider launching on multiple platforms, such as Twitter and TikTok, and consider e-cigarette use status when posting.
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Affiliation(s)
- Jessica Liu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Donghee N. Lee
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Elise M. Stevens
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
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Zheng X, Lin HC. How Does Online e-cigarette Advertisement Promote Youth's e-cigarettes Use? The Mediating Roles of Social Norm and Risk Perceptions. HEALTH COMMUNICATION 2023; 38:1388-1394. [PMID: 34872415 DOI: 10.1080/10410236.2021.2010350] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The adoption of the internet, social media, and e-cigarettes are on the rise among U.S. youth. Uses of social media and online platforms increase the probability for youth to encounter e-cigarette advertisements. Departing from this line of reasoning, we examine the underlying mechanisms of how online e-cigarettes exposure promotes youth's e-cigarette use. Drawing on insights from the social construction of risk model, this study looks at how perceived social norms and risk perception mediate the link between online e-cigarette advertisement exposure and e-cigarette use. Youth aged 12-17 from the Public Assessment of Tobacco and Health (PATH) Study Waves 2-4 (2014-2018) were included (N = 6,067). Controlling for demographic and other known risk factors for e-cigarette use, respondents who had been exposed to online e-cigarette ads at Wave 2 perceived higher levels of positive social norms of e-cigarette use at Wave 3 (β = 0.13, p < .001) which was associated with lower e-cigarette risk perception at Wave 3 (β = -0.22, p < .001). Lower e-cigarette risk perception at Wave 3 resulted in a higher likelihood of e-cigarette use at Wave 4 (AOR = 0.51, p < .001). Online e-cigarettes ads exposure at Wave 2 predicted e-cigarette use at Wave 4 (AOR = 1.87, p < .001). The results indicate that norm perception associated with online e-cigarettes ads may twist youth's e-cigarette risk perception that is associated with subsequent usage. Interventions to curb youth's e-cigarette use can target social norms of e-cigarette use and restrict e-cigarette advertisement exposure to youth.
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Affiliation(s)
- Xia Zheng
- The Media School, Indiana University at Bloomington
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43
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Janjua NA, Kreski NT, Keyes KM. Social, educational, and psychological health correlates of e-cigarette and combustible cigarette use among adolescents in the US from 2015 to 2021. Addict Behav 2023; 144:107754. [PMID: 37230022 DOI: 10.1016/j.addbeh.2023.107754] [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: 01/19/2023] [Revised: 04/04/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND The prevalence of e-cigarette and vaping products has increased in the past decade, especially among adolescents. To provide data that will inform identification of youth at high risk, the goals of this study are to determine the social, educational, and psychological health outcomes associated with e-cigarette use distinct from combustible cigarettes. METHODS Annual samples of adolescents in grade 12 (years: 2015-2021, N = 24,015) were analyzed from Monitoring the Future cross-sectional data. Students were categorized based on vaping and smoking patterns (no use, vape only, combustible cigarette smoking only, or both). Survey-weighted prevalence and logistic regression were used to assess associations. RESULTS Between 2015 and 2021, 78.7% of students used neither e-cigarettes nor combustible cigarettes, 13.2% used e-cigarettes only (vape-only), 3.7% used combustible cigarettes only (smoke-only), and 4.4% used both. Students who vaped-only (OR:1.49, CI:1.28-1.74), smoked-only (OR:2.50, CI:1.98-3.16), or both (OR:3.03, CI:2.43-3.76) had worse academic performance than non-smoking, non-vaping peers after demographic adjustment. There was no significant difference in self-esteem between the "neither" group and the other groups, though the "vaping-only", "smoking-only" and "both" groups were more likely to report unhappiness. Inconsistent differences emerged regarding personal & family beliefs. CONCLUSIONS Generally, adolescents who reported e-cigarette-only use had better outcomes than their peers who smoked cigarettes. However, students who vape-only reported poorer academic performance compared to those who did not vape or smoke. Vaping and smoking were not significantly related to self-esteem, but were linked to unhappiness. Still, vaping does not follow the same patterns as smoking, despite frequent comparisons in the literature.
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Affiliation(s)
- Nabeel A Janjua
- Morehouse School of Medicine, United Negro College Fund, United States
| | - Noah T Kreski
- Columbia University Mailman School of Public Health, United States.
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Singh I, Valavil Punnapuzha V, Mitsakakis N, Fu R, Chaiton M. A Machine Learning Approach Reveals Distinct Predictors of Vaping Dependence for Adolescent Daily and Non-Daily Vapers in the COVID-19 Era. Healthcare (Basel) 2023; 11:healthcare11101465. [PMID: 37239751 DOI: 10.3390/healthcare11101465] [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: 03/01/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Since 2016, there has been a substantial rise in e-cigarette (vaping) dependence among young people. In this prospective cohort study, we aimed to identify the different predictors of vaping dependence over 3 months among adolescents who were baseline daily and non-daily vapers. We recruited ever-vaping Canadian residents aged 16-25 years on social media platforms and asked them to complete a baseline survey in November 2020. A validated vaping dependence score (0-23) summing up their responses to nine questions was calculated at the 3-month follow-up survey. Separate lasso regression models were developed to identify predictors of higher 3-month vaping dependence score among baseline daily and non-daily vapers. Of the 1172 participants, 643 (54.9%) were daily vapers with a mean age of 19.6 ± 2.6 years and 76.4% (n = 895) of them being female. The two models achieved adequate predictive performance. Place of last vape purchase, number of days a pod lasts, and the frequency of nicotine-containing vaping were the most important predictors for dependence among daily vapers, while race, sexual orientation and reporting treatment for heart disease were the most important predictors in non-daily vapers. These findings have implications for vaping control policies that target adolescents at different stages of vape use.
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Affiliation(s)
- Ishmeet Singh
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
| | - Varna Valavil Punnapuzha
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
| | - Nicholas Mitsakakis
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Rui Fu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Research Institute, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Michael Chaiton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
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Kreski NT, Ankrum H, Cerdá M, Chen Q, Hasin D, Martins SS, Olfson M, Keyes KM. Nicotine Vaping and Co-occurring Substance Use Among Adolescents in the United States from 2017-2019. Subst Use Misuse 2023; 58:1075-1079. [PMID: 37198725 PMCID: PMC10277150 DOI: 10.1080/10826084.2023.2188462] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Background: The use of electronic cigarettes (or "vaping") among adolescents remains a public health concern given exposure to harmful substances, plus potential association with cannabis and alcohol. Understanding vaping as it intersects with combustible cigarette use and other substance use can inform nicotine prevention efforts. Methods: Data were drawn from 51,872 US adolescents (grades 8, 10, 12, years: 2017-2019) from Monitoring the Future. Multinomial logistic regression analyses assessed links of past 30-day nicotine use (none, smoking-only, vaping-only, and any smoking plus vaping) with both past 30-day cannabis use and past two-week binge drinking. Results: Nicotine use patterns were strongly associated with greater likelihood of cannabis use and binge drinking, particularly for the highest levels of each. For instance, those who smoked and vaped nicotine had 36.53 [95% CI:16.16, 82.60] times higher odds of having 10+ past 2-week binge drinking instances compared to non-users of nicotine. Discussion: Given the strong associations between nicotine use and both cannabis use and binge drinking, there is a need for sustained interventions, advertising and promotion restrictions, and national public education efforts to reduce adolescent nicotine vaping, efforts that acknowledge co-occurring use.
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Affiliation(s)
- Noah T Kreski
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Hadley Ankrum
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Qixuan Chen
- Department of Biostatistics, Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Deborah Hasin
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA
- Department of Psychiatry, New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Mark Olfson
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA
- Department of Psychiatry, New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA
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46
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Jancey J, Leaver T, Wolf K, Freeman B, Chai K, Bialous S, Bromberg M, Adams P, Mcleod M, Carey RN, McCausland K. Promotion of E-Cigarettes on TikTok and Regulatory Considerations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5761. [PMID: 37239490 PMCID: PMC10217796 DOI: 10.3390/ijerph20105761] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/22/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023]
Abstract
E-cigarettes are promoted extensively on TikTok and other social media platforms. Platform policies to restrict e-cigarette promotion seem insufficient and are poorly enforced. This paper aims to understand how e-cigarettes are being promoted on TikTok and provide insights into the effectiveness of current TikTok policies. Seven popular hashtag-based keywords were used to identify TikTok accounts and associated videos related to e-cigarettes. Posts were independently coded by two trained coders. Collectively, the 264 videos received 2,470,373 views, 166,462 likes and 3426 comments. The overwhelming majority of videos (97.7%) portrayed e-cigarettes positively, and these posts received 98.7% of the total views and 98.2% of the total likes. A total of 69 posts (26.1%) clearly violated TikTok's own content policy. The findings of the current study suggest that a variety of predominantly pro-vaping content is available on TikTok. Current policies and moderation processes appear to be insufficient in restricting the spread of pro-e-cigarette content on TikTok, putting predominantly young users at potential risk of e-cigarette use.
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Affiliation(s)
- Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Kent Street, Perth, WA 6102, Australia
| | - Tama Leaver
- Internet Studies, School of Media, Creative Arts and Social Inquiry, Curtin University, Kent Street, Perth, WA 6102, Australia
| | - Katharina Wolf
- School of Marketing, Curtin University, Kent Street, Perth, WA 6102, Australia
| | - Becky Freeman
- School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Kevin Chai
- School of Population Health, Curtin University, Kent Street, Perth, WA 6102, Australia
| | - Stella Bialous
- School of Nursing, University of California, San Francisco, CA 94158, USA
| | - Marilyn Bromberg
- UWA Law School, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Phoebe Adams
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Kent Street, Perth, WA 6102, Australia
| | - Meghan Mcleod
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Kent Street, Perth, WA 6102, Australia
| | - Renee N. Carey
- School of Population Health, Curtin University, Kent Street, Perth, WA 6102, Australia
| | - Kahlia McCausland
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Kent Street, Perth, WA 6102, Australia
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47
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Sun T, Lim CCW, Chung J, Cheng B, Davidson L, Tisdale C, Leung J, Gartner CE, Connor J, Hall WD, Chan GCK. Vaping on TikTok: a systematic thematic analysis. Tob Control 2023; 32:251-254. [PMID: 34312317 DOI: 10.1136/tobaccocontrol-2021-056619] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/21/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The rising popularity of TikTok among adolescents may influence their awareness and perceptions of e-cigarette use via user-generated content. This study aimed to examine how e-cigarette/vaping-related videos are portrayed on TikTok. METHODS The nine most viewed hashtag based keywords were used to identify popular e-cigarette/vaping-related videos on TikTok (n=1000) from its inception (earliest upload date: January 2019) to November 2020. Five researchers independently coded the number of views, likes, user category and theme. RESULTS A final sample of 808 e-cigarette/vaping-related videos that met study criteria were included. Collectively, these videos were viewed over 1.5 billion times, with a median view count of 1 000 000 (range 112 900-78 600 000) and a median 'likes' count of 143 000 (range 10 000-1 000 000). A majority of the videos portrayed e-cigarette use positively (63%; collectively viewed over 1.1 billion times). Neutral depictions of e-cigarette use were viewed a total of 290 million times (24%) and negative depictions of e-cigarettes were viewed a total of 193 million times (13%). The video themes included (not mutually exclusively): 'comedy and joke' (52%; total of 618 million views), 'lifestyle and acceptability' (35%; 459 million), 'marketing' (29%; 392 million), 'vaping tricks' (20%; 487 million), 'nicotine and addiction' (20%; 194 million), 'creativity' (16%; 322 million) and 'warning' (11%; 131 million). CONCLUSION Our findings illustrated that positively framed e-cigarette and vaping-related postings available without age restrictions on TikTok-a rising video-sharing platform that is popular among adolescents-have been viewed many times. Effective age restrictions are needed to reduce adolescents' potential exposure to videos that portray vaping positively.
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Affiliation(s)
- Tianze Sun
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia .,School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia.,NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Carmen C W Lim
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia.,School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia.,NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jack Chung
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia.,School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Brandon Cheng
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia.,School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Lily Davidson
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Calvert Tisdale
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia.,School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia.,National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, NSW, Australia
| | - Coral E Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jason Connor
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia.,Discipline of Psychiartry, The University of Queensland, Brisbane, Queensland, Australia
| | - Wayne D Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Gary C K Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia.,NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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48
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Maglalang DD, Fong L, Gapuz VJ, Navarro K, Yoo GJ, Le MN. Social Influence of E-cigarette Use among Asian Americans in California. Am J Health Behav 2023; 47:173-181. [PMID: 36945099 PMCID: PMC10161783 DOI: 10.5993/ajhb.47.1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Objectives: The use of e-cigarettes is on the rise in the United States (US). An understudied facet of e-cigarette use is the influence of social groups. The purpose of the present article is to examine the role of social groups in the use of e-cigarettes among Asian Americans. Methods: We conducted 12 semi-structured interviews of Asian Americans who use e-cigarettes living in California. Interviews were transcribed and analyzed using thematic analysis. Results: Findings showed that e-cigarette use is normalized and encouraged among peer groups and social gatherings, anecdotal success stories of their peers who were able to quit or reduce their use of combustible cigarettes using e-cigarettes were motivating, and vape shops provided a space for socialization and belonging. Conclusions: The findings illuminate that e-cigarette use is a mediator in Asian American social groups as an activity for collectivity and connection. Public health researchers and practitioners can address nicotine use or addiction among Asian Americans through group or peer targeted prevention and intervention strategies.
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Affiliation(s)
- Dale Dagar Maglalang
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States;,
| | - Leanna Fong
- Department of Population Health and Disease Prevention, University of California, Irvine, Irvine, CA, United States
| | - Victoria-Jo Gapuz
- Department of Sociology, Macalester College, St. Paul, MN, United States
| | - Kyle Navarro
- School Health Programs, San Francisco Unified School District, San Francisco, CA, United States
| | - Grace J Yoo
- Department of Asian American Studies, San Francisco State University, San Francisco, CA, United States
| | - Mai-Nhung Le
- Department of Asian American Studies, San Francisco State University, San Francisco, CA, United States
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49
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Rutherford BN, Lim CCW, Johnson B, Cheng B, Chung J, Huang S, Sun T, Leung J, Stjepanović D, Chan GCK. #TurntTrending: a systematic review of substance use portrayals on social media platforms. Addiction 2023; 118:206-217. [PMID: 36075258 PMCID: PMC10087142 DOI: 10.1111/add.16020] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/21/2022] [Indexed: 01/05/2023]
Abstract
AIMS There is a growing body of literature exploring the types of substance-related content and their portrayals on various social media platforms. We aimed to summarize how content related to substances is portrayed on various social media platforms. METHODS This systematic review was pre-registered on PROSPERO (ref: CRD42021291853). A comprehensive search was conducted in the databases of PubMed, Scopus, PsycINFO and Web of Science in April 2021. Original qualitative studies published post-2004 that included thematic and sentiment analyses of social media content on tobacco, alcohol, psychostimulant, e-cigarette, cannabis, opiate, stimulant/amphetamine, inhalant and novel psychoactive substance were included. Social media platforms were defined as online web- or application-based platforms that allowed users to generate content and interact via 'liking', comment or messaging features. Only studies that included summative and/or thematic content analyses of substance-related social media content were included. RESULTS A total of 73 studies, which covered 15 905 182 substance-related posts on Twitter, YouTube, Instagram, Pinterest, TikTok and Weibo, were identified. A total of 76.3% of all substance-related content was positive in its depiction of substance use, with 20.2% of content depicting use negatively. Sentiment regarding opiate use however was commonly negative (55.5%). Most studies identified themes relating to Health, Safety and Harms (65.0%) of substance use. Themes relating to Promotions/Advertisements (63.3%), Informative content (55.0%) and Use behaviours (43.3%) were also frequently identified. CONCLUSIONS Substance-related content that promotes engagement with substance use or actively depicts use appears to be widely available on social media. The large public presence of this content may have concerning influences on attitudes, behaviours and risk perceptions relating to substance use, particularly among the most vulnerable and heaviest users of social media-adolescents and young adults.
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Affiliation(s)
- Brienna N Rutherford
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia.,School of Psychology, The University of Queensland, St Lucia, Australia
| | - Carmen C W Lim
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia.,School of Psychology, The University of Queensland, St Lucia, Australia
| | - Benjamin Johnson
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia.,School of Psychology, The University of Queensland, St Lucia, Australia
| | - Brandon Cheng
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia.,School of Psychology, The University of Queensland, St Lucia, Australia
| | - Jack Chung
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia.,School of Psychology, The University of Queensland, St Lucia, Australia
| | - Sandy Huang
- School of Medicine, The University of Queensland, St Lucia, Australia
| | - Tianze Sun
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia.,School of Psychology, The University of Queensland, St Lucia, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
| | - Daniel Stjepanović
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
| | - Gary C K Chan
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
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50
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Lee J, Murthy D, Kong G. Content Analysis of YouTube Videos Related to E-cigarettes and COVID-19. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.06.23284266. [PMID: 36711470 PMCID: PMC9882443 DOI: 10.1101/2023.01.06.23284266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION E-cigarettes are frequently promoted on social media and portrayed in ways that are attractive to youth. While COVID-19 pandemic significantly affected people's lives, less known is how the pandemic influenced e-cigarette-related marketing and information on social media. This study identifies how e-cigarettes are portrayed during the COVID-19 pandemic on YouTube, one of the most popular social media platforms. METHODS We searched for combinations of search terms related to e-cigarettes (i.e., "electronic cigarette", "e-cigarette", "e-cig", "vape" and "vaping") and COVID-19 (i.e., "corona", "COVID", "lockdown" and "pandemic"). To be included in the analysis, the video must be: uploaded after February 1, 2020, in English, related to e-cigarettes and COVID-19 and less than 30 minutes in length. We assessed video themes related to e-cigarettes and COVID-19, uploader characteristics, and featured e-cigarette products. RESULTS We examined N=307 videos and found that N=220 (73.6%) were related to the health effects of e-cigarette use on COVID-19, followed by videos of how COVID-19 affects e-cigarette access/sales (N=40, 12.9%), and face mask-related videos (N=16, 5.1%) which included content regarding masks and e-cigarette use. Instructional videos on how to modify e-cigarettes to use with masks had the highest number of likes (Median=23; IQR=32) and comments (Median=10; IQR=7). CONCLUSIONS This study identified various e-cigarette contents on YouTube during the COVID-19 pandemic. Our findings support the need for continuous surveillance on novel vaping-related content in reaction to policies and events such as the global pandemic on social media is needed.
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Affiliation(s)
- Juhan Lee
- Yale University School of Medicine, New Haven, CT, USA
| | - Dhiraj Murthy
- University of Texas at Austin, School of Journalism and Media, Department of Sociology, Austin, TX, US
| | - Grace Kong
- Yale University School of Medicine, New Haven, CT, USA
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