Social Media More Likely to Promote Positive Views of E-Cigarettes

NEW YORK CITY -- Despite efforts to curb such content, the majority of sponsored Instagram posts featuring electronic nicotine delivery systems (ENDS) -- such as e-cigarettes -- promoted their use to adolescent users or portrayed the products in a positive way, researchers found.

Out of 51 ENDS-related posts on Instagram, two-thirds portrayed e-cigarettes or vapes positively compared to one-fourth that portrayed them negatively, Jessica Tran, BS, a fourth-year medical student at the University of Texas Medical Branch in Galveston, and colleagues reported at the American Psychiatric Association (APA) annual meeting.

More than half of posts analyzed were promotional (58.8%), while just 27.5% were educational, they noted.

"In our study, we found that there were a lot of influencer accounts who promoted products or represented a brand -- and were termed vape ambassadors -- and in return these people get compensated or they get the opportunity to expand their social media following," Tran told MedPage Today.

Indeed, influencers and ambassadors accounted for 41.2% and 19.6% of the posts, respectively, Tran and colleagues found.

More than 2.1 million youth currently use e-cigarettes, with more than a quarter of them using one every day. Exposure to e-cigarettes on social media is associated with increased use.

Despite the FDA's rule requiring health warnings on ENDS ads and Instagram's ban on promoting ENDS products since 2019, Tran said the majority of ad-related content they analyzed violated those rules and regulations.

In fact, two-thirds of posts did not contain warnings about age restrictions or the potential of nicotine addiction, which violated the FDA regulations.

"Evidently, there's a need for further guidance and enforcement to ensure that ENDS marketers on social media are adherent to current provisions and more drastic steps can be taken to remove sponsored social media accounts," Tran said.

The most common marketing strategies included posts appealing to lifestyle, youth culture, humor, and emotion. Posts focused on humor and lifestyle tended to have the highest levels of engagement, she added.

Tran explained that these findings highlight the need for more educational content about ENDS that uses effective marketing strategies -- such as appealing to humor and lifestyle -- to increase youth engagement.

Howard Liu, MD, of the University of Nebraska Medical Center and chair of the APA Council on Communications, agreed that these results are "concerning," and there is a serious need to address the spread of positive messaging around the use of e-cigarettes and vapes on social media.

"Really, public health information is spread on social media, and we know that the youth eyeballs are really going to be on newer social media platforms, like Instagram, TikTok, and YouTube as well," said Liu, who was also the session moderator. "It's really important for us as healthcare organizations to be on those platforms to make sure that we're spreading accurate information."

To conduct the analysis, researchers used a new 14-year-old female profile to query ENDS-related posts on Instagram in December 2023. Using an incognito web browser, they searched for sponsored posts using the hashtags #vaping, #vapelife, #vapestagram, #vapefam, #eliquid, #ejuice, #ecig, #vapenation, #vapelyfe, and #vapecommunity.

They then collected the top 27 publicly available posts from each hashtag and excluded posts that were duplicates, not in English, or unrelated to ENDS content. The 51 remaining posts were assessed by two reviewers independently for engagement, accuracy of information, the presence of health-related warnings, and the overall depiction of ENDS products.

While the results of the analysis suggested that regulatory policies were inadequate in preventing adolescents from being routinely exposed to promotional ENDS-related content on Instagram, the authors noted that mental health professionals may be able to play a more active role in addressing this issue.

"More than half of the posts were shared by ambassadors [and] individuals; very few were shared by healthcare organizations or public health organizations," Tran said. "[This] is a great avenue that public health and educational medical organizations can step in and try to appeal to youth to portray the negative aspects of ENDS and dissuade youth from starting to use them."

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