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Nicotine Tob Res. 2020 Jan 8. pii: ntaa003. doi: 10.1093/ntr/ntaa003. [Epub ahead of print]

Effects of Social Media on Adolescents' Willingness and Intention to Use E-Cigarettes: An Experimental Investigation.

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Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA.
Hopelab, San Francisco, CA.
Division of Adolescent & Young Adult Medicine, University of California, San Francisco, San Francisco, CA.
Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford CA.



This study examined effects of experimentally manipulated social media exposure on adolescents' willingness and intention to use e-cigarettes.


Participants were 135 adolescents age 13-18 (52.6% female, M age=15.3) in California. Participants viewed 6 social media posts online in a 2 (post source: peer or advertisement) X 2 (e-cigarette content exposure: heavy or light) between-subjects design. Analyses were weighted to population benchmarks. We examined adolescents' beliefs, willingness, and intention to use e-cigarettes in association with social media use intensity in daily life and with experimentally manipulated exposure to social media posts that varied by source (peer or advertisement) and content (e-cigarette heavy or light).


Greater social media use in daily life was associated with greater willingness and intention to use e-cigarettes and more positive attitudes, greater perceived norms, and lower perceived danger of e-cigarette use (all p-values<.01). In tests of the experimental exposures, heavy (versus light) e-cigarette content resulted in greater intention (p=.049) to use e-cigarettes and more positive attitudes (p=.019). Viewing advertisements (versus peer-generated posts) resulted in greater willingness and intention (p-values<.01) to use e-cigarettes, more positive attitudes (p=.003), and greater norm perceptions (p=.009). The interaction effect of post source by post content was not significant for any of the outcomes (all p-values>0.529).


Greater social media use and heavier exposure to advertisements and e-cigarette content in social media posts are associated with a greater risk for e-cigarette use among adolescents. Regulatory action is needed to prohibit sponsored e-cigarette content on social media platforms used by youth.


ENDS; Prototype Willingness Model; adolescent; advertisement; e-cigarette; intention; social media


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