Social media use linked to tobacco initiation among youth

The tobacco industry has long appealed to youth through targeted marketing that glamorizes smoking with imagery of candy-flavored products, celebrity endorsements, social settings, and other enticing tactics. That marketing approach appears to be particularly effective on social media, according to a new study led by Boston University School of Public Health (BUSPH) researchers.

Published in the journal Addictive Behaviors, the study found that frequent social media use was linked to an increased risk of youth using any tobacco product—including vaping—for the first time after one year.

Youth with no prior tobacco use who used social media daily were 67% more likely to begin smoking after one year, compared to youth who used these platforms less frequently. The results also showed that youth who actively engaged with tobacco marketing by liking or following content by major tobacco brands developed an even greater risk of first-time tobacco use.

As almost all young people are active on social media and engage with sites such as Instagram and TikTok repeatedly throughout the day, these findings raise concern about youth exposure to promotional content of harmful products. While national cigarette smoking rates have declined substantially among US youth since the mid-1990s, an estimated 10% of middle and high school students—2.8 million people—currently use at least one tobacco product, and many also engage in dual use, particularly with e-cigarettes.

These findings underscore tobacco use as a persistent public health issue and underscore the need for more research on how tobacco advertising on social media may contribute to this problem.

"Our results add to a growing body of literature documenting the harms of social media use for this age group, as well as how commercial interests such as the tobacco industry are targeting kids on these platforms," says study lead and corresponding author Dr. Lynsie Ranker, assistant professor of community health sciences at BUSPH.

For the study, Dr. Ranker and colleagues examined possible associations between social media engagement and tobacco initiation risk utilizing data from the US Population Assessment for Tobacco and Health study, a nationally representative study of US youth ages 12 years and older, led by the National Institute on Drug Abuse and the Food and Drug Administration.

Focusing on data during two waves of the study from 2014-2016, the team identified 8,672 youth who had never used tobacco products before. Among this group, 63.5% used social media daily, and 3.3% liked or followed one or more tobacco brands on social media.

Youth who engaged directly with tobacco brands on these sites were 34% more likely to begin using any tobacco product for the first time, and 60% more likely to start using more than one tobacco product. The findings on liking/following content and multi-product use were imprecise, but they support a growing body of research that points to young people's increasing online activity.

"It is not surprising that tobacco manufacturers target youth through social media," says study co-author Dr. Traci Hong, professor of media science at Boston University College of Communication. "While state and national efforts to curb social media use among youth continue to evolve, we should also focus on regulating the promotion of tobacco products on social media, as well as educating our youth about the risks of tobacco use."

While the US Food and Drug Administration expanded its regulatory authority over the marketing of new and emerging tobacco products in 2016, restrictions on tobacco advertising on social media is largely at the discretion of the social media companies, rather than government officials.

The researchers also note that these restrictions primarily apply to paid promotional content with the platforms, leaving loopholes for tobacco companies to target youth through branded accounts and collaborations with influencers.

"Based on our research, social media platforms lack self-regulation," says study co-author Dr. Jessica Fetterman, assistant professor of medicine at Boston University Chobanian & Avedisian School of Medicine.

"They have their own policies against tobacco marketing, yet many leading tobacco companies are able to maintain their own branded accounts to market their products. The government must step forward to regulate tobacco marketing on social media, just as they have done for other forms of media such as TV and print ads."

This issue should be tackled from multiple angles, says study senior author Dr. Ziming Xuan, professor of community health sciences at BUSPH.

"At an individual level, it is critical to improve the way we measure social media content exposure as a key factor in determining subsequent risky behaviors among youth," Dr. Xuan says. "At a societal level, we must continue our efforts in building a stronger evidence base on the set of most effective policies to restrict tobacco content towards youth population on social media."