Evaluating the impact of e-cigarette social media marketing on e-cigarette use among underage youth.

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Abstract/Project summary E-cigarettes are a big problem among high school students – with rates of daily use exploding from 12% in 2017 to 28% in 2019. Adolescents are exposed to e-cigarette endorsements from social media influencers who promote these harmful products on behalf of e-cigarette brands as a healthier alternative to conventional cigarettes. This project proposes to comprehensively describe e-cigarette influencer marketing on Instagram (the most widely used platform for e-cigarette influencers) and on other social media platforms popular among U.S. teenagers; to examine associations between exposure to social media marketing and patterns of initiation and change in e-cigarette use; and to explore youth attitudes and ideas related to e-cigarette influencers and e- cigarette prevention campaigns. For Aim 1, we will use innovative, validated deep-learning models - a form of artificial intelligence that automatically discovers patterns in data - to evaluate trends in marketing themes and compliance with federal requirements for warning labels and sponsorship disclosures in e-cigarette promotional images and videos on Instagram, YouTube and TikTok to be collected from 2021 to 2023 (over four million posts, in all). We will use ANOVA tests to examine temporal trends in user engagement with e-cigarette marketing posts and compare the proportion of underaged users among followers of e-cigarette influencers on these platforms over the two-year period. For Aim 2, we will measure the association of exposure to e-cigarette marketing (on Instagram, YouTube, TikTok and Snapchat) with subsequent initiation, escalation or cessation of e-cigarette use among a socioeconomically- and racially-diverse cohort of 5,000 high school students living in urban areas of Southern California via ongoing longitudinal cohort surveys (2021-2023). We will use three waves of survey data in multilevel multinomial logistic regression to measure changes in exposure to- and engagement with e-cigarette marketing on Instagram, YouTube, TikTok and Snapchat; we will use repeated-measures random effects logistic regression models to evaluate the association of exposure to marketing content on these platforms with subsequent changes in e-cigarette use. Ten focus groups among survey participants will complement survey findings and will be analyzed using the Grounded Theory method. Using the social media data, surveys and focus groups, we will also quantify and characterize the level of exposure to- and perception of anti-e-cigarette prevention campaigns on social media. This project will be the first to thoroughly evaluate changes in e-cigarette use habits among youth as a result of exposure to e-cigarette marketing and interaction with e-cigarette influencers on the most popular social media platforms among adolescents.