Assessing the Appeal of Instagram Electronic Cigarette Refill Liquid Promotions and Warnings Among Young Adults: Mixed Methods Focus Group Study

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

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.

E-cigarette brands and social media influencers on Instagram: a social network analysis

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.

Examining influencer compliance with advertising regulations in branded vaping content on Instagram

Background

Youth and young adults are exposed to vaping advertisements on social media sites, despite regulations and guidelines intended to reduce the prevalence of such content on these platforms. This research uses replicable criteria to identify vaping influencers who have worked with vaping brands to promote vaping products on Instagram and documents the extent to which posts by these users comply with existing advertising regulations.

Methodology

We conducted three google searches collecting eight different vaping influencer lists, with a total of 575 unique influencers. We limited our sample to public accounts with 100,000 followers or more (n = 54). An initial sample of 360 Instagram posts was used to identify an analytic sample of 262 vape-related posts from 2021. We conducted a conceptual content analysis to first identify unambiguous vaping advertisements (branded content), and then code ads for compliance with existing regulations.

Results

On average, the 54 Instagram accounts had 265,851.9 followers (sd = 383,349.8) and 4,158 posts (sd = 7,302.1). Most posts featured vaping products 239 (91.2%), with 186 (76.2%) posts being unambiguously branded vape advertisements and 31 (14.3%) even including purchase links in the post itself. However, one post complied with FTC disclosure guidelines. Although 50 (20.9%) had warning labels, only 8 (15.1%) were fully compliant with FDA warning label guidelines.

Discussion

Findings demonstrate minimal compliance with existing regulations among influencers known to have financial relationships with vaping brands. Most influencer posts are unambiguous, branded, vaping advertisements. Implications for barriers to regulating influencer content and the need for greater enforcement resources are discussed.

How Does Social Media Exposure and Engagement Influence College Students' Use of ENDS Products? A Cross-lagged Longitudinal Study

Electronic nicotine delivery systems (ENDS) products have been marketed heavily on social media throughout the past years, which exerts great influence on young adults' ENDS use. Despite scholars' pioneering efforts in investigating the influence of tobacco and nicotine products marketing on young adults' vaping behavior, scholarly attention has been paid primarily to passive exposure to rather than active engagement with the information on social media. In addition, the majority of existing research has been cross-sectional or focused on the unidirectional path from marketing information to behavior. To extend previous research in tobacco regulatory science on new media, we examined the bidirectional associations between self-reported exposure to and engagement with tobacco and nicotine products messaging on social media, and subsequent use of ENDS products one year later among a large, diverse sample of young adults. Results from cross-lagged panel analyses indicated that pro-tobacco/ENDS engagement and advertising exposure elevated risk whereas anti-tobacco/ENDS engagement decreased risk for the subsequent use of ENDS products one year later. On the other hand, the use of ENDS products positively predicted both pro- and anti-tobacco/ENDS engagement one year later. Findings provide empirical support for the reasoned action approach and the confirmation bias rooted in cognitive dissonance theory through rigorous longitudinal examination. Our findings not only point to the imperativeness of and offer guidance for regulating marketing information on social media, but also suggest social media as a promising platform to prevent young adults from initiating ENDS product use.

How Age and E-cigarette Use Status Interact to Influence E-cigarette Ad Perceptions

Background: The prevalence of e-cigarette use among young people remains high. Young people are susceptible to e-cigarette advertising, although potential heterogeneity in perceptions of e-cigarette ads with respect to age and e-cigarette use history remains unexplored. We aimed to assess differences in perceptions of e-cigarette ads and product use intention, by age and e-cigarette use status. Methods: Participants from an online convenience sample (N = 497, Mage=31.9) viewed two randomly selected e-cigarette ads and reported their perceptions of the ads and product use intention. We used mixed effects linear regression models to estimate associations between age group (18-20 years, 21-25 years, 26+ years), e-cigarette use status (never, former, and current use), and their interaction effects, on outcomes related to perceptions of ads and use intention. Models controlled for demographics and other tobacco use. Results: Current e-cigarette users (vs. never users) and participants who were 26+ years old (vs. 18-20 years old) had greater liking of the ads, perceived ad relevance, and perceived ad effectiveness. Among current e-cigarette users, participants who were 26+ years old (vs. 18-20 years old) had lower use intention. Conclusion: The effect of e-cigarette ad exposures on perceptions of the ad and use intention is heterogeneous with respect to age group and e-cigarette use history. While ads appealed more to adults who were 26+ years old across e-cigarette use groups, current e-cigarette users who were 18-20 years old demonstrated high use intention following ad exposure, suggesting a need for marketing interventions to mitigate continued e-cigarette use among young people.

E-Cigarette Advertising in the UK: A Content Analysis of Traditional and Social Media Advertising to Observe Compliance with Current Regulations

INTRODUCTION

The advertising of e-cigarettes in the UK is regulated through the revised EU Tobacco Products Directive and the Tobacco and Related Products Regulations, with further rules set out in the Advertising Standards Authority (ASA) Committees of Advertising (CAP) Code. Focusing on the ASA CAP Code Rules, we examined e-cigarette advertising regulation compliance in traditional advertising channels and on social media.

METHODS

We conducted a content analysis of UK e-cigarette and related product advertising using a randomly selected sample (n = 130) of advertising in traditional channels and on Instagram which appeared between January and December 2019. All ads were independently double-coded to assess compliance with each CAP Code Rule.

RESULTS

In traditional channels, our sample of advertising had largely good compliance. Only very small numbers of these ads appeared to be clearly in breach of any of the ASA rules (5% were in breach of Rule 22.7; 2% of Rule 22.9; and 1% of Rule 22.10). In contrast, we judged that all of the Instagram sample (n = 30) was in breach of Rule 22.12. For some rules, it was not possible to make definitive judgments about compliance, given uncertainty regarding how a rule should be interpreted and applied.

CONCLUSIONS

We found overall good compliance for advertising in traditional channels, but assessed all of our social media advertising samples was in breach of regulations. Current guidance on e-cigarette advertising could be improved to facilitate e-cigarette advertising assessment and regulation. It would be beneficial to bring consumer perspectives into the assessment of regulation compliance.

IMPLICATIONS

The regulation of e-cigarette advertising is a global concern. The UK Government has a statutory obligation to review the Tobacco and Related Products Regulations by May 2021. This study assessed compliance with current UK e-cigarette advertising regulations on placement and content. We identified areas where greater clarity is needed and outlined implications for future regulation.

E-cigarette advertising exposure among South African adults in 2017: findings from a nationally representative cross-sectional survey

OBJECTIVES

In South Africa, the Control of Tobacco and Electronic Delivery Systems Bill seeks to regulate e-cigarettes as tobacco products, including their advertising, promotion and sponsorship. Population data on e-cigarette advertising in South Africa are needed to inform public health programs, practice and policy. We examined self-reported e-cigarette advertising exposure during 2017. DESIGN: Cross-sectional.

SETTING

Household-based survey.

PARTICIPANTS

3063 individuals who participated in the 2017 South African Social Attitudes survey, a nationally representative, in-person survey of the non-institutionalised civilian adult population aged ≥16 years EXPOSURE: 'In the past 12 months, have you seen advertisements or promotions for e-cigarettes (including e-shisha, e-pipe) on any of the following media: newspapers/magazines, billboards, in the malls or any other source?'

MAIN OUTCOMES

Beliefs and attitudes regarding e-cigarettes.

FINDINGS

Participants' mean age was 37.7 years. Overall, 20.1% reported exposure to e-cigarette advertisements. By age, exposure was most prevalent among those aged 16-19 years (24.6%). Top sources of exposure among those exposed were stores, 40.7%; malls, 30.9%; and television, 32.5%. Of those aware of e-cigarettes, 61.2% believed 'e-cigarette advertisements and promotion may make adolescents think of smoking traditional cigarettes'; 62.7% believed that 'e-cigarette advertisements and promotions may make ex-smokers think of starting smoking cigarettes again'; and 59.5% supported the statement that 'e-cigarette smoking should be banned indoors just as traditional cigarette smoking'. Notably, teens aged 16-19 reported the lowest prevalence (49.0%) of those believing that 'e-cigarette advertisements and promotion may make adolescents think of smoking traditional cigarettes', whereas this percentage was highest among those aged 55-64 years (73.2%).

CONCLUSION

Comprehensive regulatory efforts are needed to address e-cigarette advertising, marketing and sponsorship in order to protect public health. The urgent enactment of the new tobacco control legislation, The Control of Tobacco Products and Electronic Delivery Systems Bill, can help reduce youth exposure to e-cigarette advertising in South Africa.

Negative Perceptions of Young People Using E-cigarettes on Instagram: An Experiment with Adolescents

BACKGROUND

Although e-cigarette marketing on social media increases positive attitudes and experimentation, little is known about non-influencer e-cigarette portrayals of young people.

METHODS

High school adolescents (n=928, 15-18) were recruited by Lightspeed Health for an online experiment and randomized to view an Instagram post with or without e-cigarette use. Outcomes were positive and negative perceptions (prototypes), social distance, and willingness to use.

RESULTS

Half (50%) of participants were susceptible to e-cigarette use. E-cigarettes shown (vs. not) led to less positive prototypes, p=.017, more negative prototypes, p=.004, and more social distance, p<.001. Negative prototypes and social distance were moderated by susceptibility (both p<.05); effects among non-susceptible adolescents only. Showing e-cigarettes did not impact willingness to use if offered.

DISCUSSION

Negative perceptions of e-cigarettes use challenge assumptions that vaping online is universally admirable. Highlighting unfavorable opinions of vaping or negative impacts for adolescents' social image are potential strategies for tobacco counter-marketing.

IMPLICATIONS

Despite daily use of visual-based social media by most adolescents, little is known about the influence of e-cigarette use among young people online. Adolescent negative perceptions and desired distance from non-influencers using e-cigarettes on Instagram indicate digital e-cigarette portrayals are not universally accepted. Negative impacts for adolescents' social image present a counter-marketing strategy.

Visual Attention to the Use of #ad versus #sponsored on e-Cigarette Influencer Posts on Social Media: A Randomized Experiment

Youth and young adults are the largest consumers of social media content. Individuals with large followers are paid to share social media content using specific products for compensation. This type of activity is considered commercial sponsorship and requires a disclosure in order to comply with Federal Trade Commission regulations. Between July and August 2019, youth and young adult (ages 16-24; n = 200) participants were recruited into an eye-tracking laboratory to view their native Instagram feed on a mobile device where a set of posts from e-cigarette influencers were inserted with one of the two potential labeling strategies: #ad and #sponsored. Participants spent an average of 6.6 seconds viewing e-cigarette influencer posts. Youth and young adults spent 3.1 seconds on the area labeled #ad, compared to 2.2 seconds on the area of interest labeled #sponsored (p = .03). After accounting for age, current tobacco use, and dependence, #ad drew 0.93 seconds more than #sponsored on influencer posts (p = .02). Both labeling strategies drew visual attention to Instagram e-cigarette influencer posts, with nearly 1 second more attention paid to the presence of #ad. Labeling commercially sponsored content on social media is a viable strategy to attract the attention of youth and young adults.

Compliance With FDA Nicotine Warning Statement Provisions in E-liquid Promotion Posts on Instagram

INTRODUCTION

Effective August 2018, the U.S. Food and Drug Administration (FDA) required that nicotine addiction warnings be placed on ads for nicotine containing e-liquids. As per FDA comments, this provision pertains to visual ads communicated via social media, raising questions about compliance within the large e-liquid promotion community on Instagram.

AIMS AND METHODS

This study examines use of warnings on promotional Instagram posts before and after provisions took effect on August 10, 2018. Netlytic was used to gather a sample of 500 promotional #eliquid and #ejuice posts from: May 2017, October 2017, March 2018, August 2018, and September 2018. The 1500 prewarning and 1000 postwarning posts were coded using content analysis. Changes in products and marketing strategies were also considered. Post volume was tracked monthly between May 2017 and February 2020.

RESULTS

In the prewarning period, nicotine warning statements were absent on all posts. Following August 10, 2018, FDA compliant warnings were present on 13.6% of posts. Among US-based posts, 36.4% used the warnings, with warnings more common on posts made by e-liquid brands (52.3%) and posts promoting e-liquids with nicotine (40.0%). Promotional strategies and products did not significantly change. The share of posts made by US Instagram users decreased by 11%, although total post volume continued to grow.

CONCLUSIONS

Many e-liquid promotion posts on Instagram remained noncompliant with nicotine warnings after FDA provisions took effect. The large volume of international users also limited the impact of FDA-mandated warnings on the social media environment.

IMPLICATIONS

Further guidance and enforcement are needed to ensure that US e-liquid marketers on visual social media platforms adhere to current provisions, particularly for individual social media users who are sponsored by industry. The inherently global span of social media also indicates the importance of a shared approach to marketing regulations. Further work is needed to assess enforcement strategies viable for the social media environment.

Young Adult Identification and Perception of Hashtag-Based Vaping Claims on Instagram

Social media platforms are home to large volumes of ambiguous hashtag-based claims about the health, modified-risk, and cessation benefits of electronic cigarette products (e.g., #Vapingsavedmylife). The objective of this study was to qualitatively explore how young adults interpret these hashtags on the popular platform Instagram. Specifically, we sought to identify if they view these hashtags as making health-related claims, and if they find these claims to be credible and valid. We conducted 12 focus groups in 2018 with non-tobacco users, smokers, dual users, and vapers between the ages of 18 and 24 (n = 69). Using real Instagram posts to guide discussion, participants reflected on the meaning of potentially claims-making hashtags. Participants interpreted the majority of the hashtags as making health-related claims. However, many participants felt that the claims were too exaggerated to be entirely valid. Some participants, including dual users and vapers, argued that smoking and vaping were largely equivalent. Smokers were particularly skeptical of claims. Findings suggest that the U. S. Food and Drug Administration should consider hashtag-based claims in their regulatory efforts. However, further research is needed on how to pragmatically address claims taking the form of hashtags given legal and practical constraints.