BACKGROUND: The increase in youth vaping remains a public health concern because exposure to vaping-related content influences initial e-cigarette use. However, youth already engaged in e-cigarette use could also be susceptible to seeing e-cigarette advertisements online. This study examined the bidirectional association between exposure to e-cigarette content on social media and e-cigarette use.
METHODS: The study sample included U.S. adolescents from the Population Assessment of Tobacco and Health Study of waves 5 (n=12098; 2019), 5.5 (n=7129; 2020), and 6 (n=5652; 2021). Univariable and multivariable weighted logistic regression analyses were conducted to examine the bidirectional effect of exposure to e-cigarette advertising and e-cigarette use.
RESULTS: Exposure to e-cigarette advertisements in Wave 5/Wave 5.5 was significantly associated with past 30-day use in Wave 6 (adjusted odds ratio (aOR)=2.02, 99.17% CI=1.13 to 3.62). However, the association between adolescents who used e-cigarettes in the past 30-day e-cigarette at Wave 5/Wave 5.5 was not linked to subsequent exposure to e-cigarette advertisements on social media at Wave 6 (aOR=1.27, 99.17% CI=0.72 to 2.24). In contrast, a dose-response relationship was observed between past 30-day e-cigarette use at Wave 5/Wave 5.5, and the frequency of exposure to combined tobacco and e-cigarette advertisements compared to no exposure in Wave 6 (aOR for daily/near daily exposure=2.37; aOR for weekly exposure =2.16; aOR for occasional exposure=1.37).
CONCLUSIONS: Adolescents’ exposure to e-cigarette advertisements is associated with an elevated risk of vaping, and among those who vaped, they are also likely to encounter tobacco-related content on a regular basis on social media. These findings suggest a potentially reinforcing cycle in which individuals already using e-cigarettes more frequently encounter e-cigarette advertisements.