E-cigarette use is increasing dramatically among adolescents as social media marketing portrays "vaping" products as healthier alternatives to conventional cigarettes. In September 2018, the Food and Drug Administration (FDA) launched an anti-vaping campaign, in U.S. high schools, on social media and other platforms, emphasizing "The Real Cost" of e-cigarettes. Using a novel deep learning approach, we assessed changes in vaping-related content on Instagram from 2017 to 2019 and drew an inference about the initial impact of the FDA's Real Cost campaign on Instagram. We collected 245,894 Instagram posts that used vaping-related hashtags (e.g., #vape, #ejuice) in four samples from 2017 to 2019. We compared the "like" count from these posts before and after the FDA campaign. We used deep learning image classification to analyze 49,655 Instagram image posts, separating images of men, women, and vaping devices. We also conducted text analysis and topic modeling to detect the common words and themes in the posted captions. Since September 2018, the FDA-sponsored hashtag #TheRealCost has been used about 50 times per month on Instagram, whereas vaping-related hashtags we tracked were used up to 10,000 times more often. Comparing the pre-intervention (2017, 2018) and post-intervention (2019) samples of vaping-related Instagram posts, we found a threefold increase in the median "like" count (10 vs. 28) and a 6-fold increase in the proportion of posts with more than 100 likes (2 vs. 15%). Over 70% of Instagram vaping images featured e-juices and devices, with a growing number of images depicting a "pod," the type of discrete vaping device that delivers high concentration of nicotine and is favored by novice e-cigarette users. In addition, the Instagram analytics data shared by the vaping influencers we interviewed showed underage Instagram users among their followers.

BackgroundExposure to visual posts featuring e-cigarette products on social media is associated with increased e-cigarette use among US adolescents. Instagram is the largest source of e-cigarette social media marketing, where influencers—for example, bloggers, brand ambassadors—post promotional materials. This study analysed the network of e-cigarette brands and influencers on Instagram, characterising the most central players in e-cigarette social media marketing.MethodsWe tracked influencers with public profiles on Instagram who posted promotional e-cigarette content in 2020, had over 1000 followers and high user engagement rate (ratio of likes and comments to followers) of 1%–25% per post. By conducting a social network analysis, we identified the most central (highly involved in promotional activities) influencers and e-cigarette brands. The number of the influencers’ followers aged 13–17 years old and the age verification practices restricting youth access were also assessed.ResultsThere is a highly interconnected network of engaging e-cigarette influencers (n=55) worldwide who collaborated with over 600 e-cigarette brands in 2020. The Asian and US influencers had five to six times more teenage followers compared with the European influencers. 75% of the influencers did not restrict youth access to their promotional content on Instagram. The brands Voopotech, Innokin, Geekvape, Lost Vape, Smok and Vaporesso collaborated with the largest number of influencers (mean n=20).ConclusionsIt is important to understand associations among influencers and e-cigarette use behaviours, especially youth, to inform effective public health communication and potential policies that could regulate social media marketing sponsored by e-cigarette companies.

Tobacco promotion is prolific on social media, with each platform setting their own restrictions on tobacco promotion and sales. We evaluated the policies related to tobacco product promotion and sales on 11 sites that are popular with youth in May 2021: Discord, Facebook, Instagram, Pinterest, Reddit, Snapchat, TikTok, Tumblr, Twitch, Twitter and YouTube. Nine of the 11 sites prohibitedpaid advertisingfor tobacco products. However, only three of them clearly prohibitedsponsored content(ie, social influencers) that promotes tobacco. Six platforms restricted content thatsells tobacco productsand three tried toprohibit underage accessto content that promotes or sells tobacco products. Although most platform policies prohibited paid tobacco advertising, few addressed more novel strategies, such as sponsored/influencer content and few had age-gating to prevent youth access. There is a pressing need to regulate tobacco promotion on social media platforms.

Introduction Effective August 2018, the U.S. Food and Drug Administration required that nicotine addiction warnings be placed on ads for nicotine containing e-liquids. As per FDA comments, this provision pertains to visual ads communicated via social media, raising questions about compliance within the large e-liquid promotion community on Instagram. Methods This study examines use of warnings on promotional Instagram posts before and after provisions took effect on August 10th, 2018. Netlytic was used to gather a sample of 500 promotional #eliquid and #ejuice posts from: May 2017, October 2017, March 2018, August 2018, and September 2018. The 1,500-pre-warning and 1,000-post-warning posts were coded using content analysis. Changes in products and marketing strategies were also considered. Post volume was tracked monthly between May 2017 and February 2020. Results In the pre-warning period, nicotine warning statements were absent on all posts. Following August 10th, 2018, FDA compliant warnings were present on 13.6% of posts. Among US-based posts, 36.4% used the warnings, with warnings more common on posts made by e-liquid brands (52.3%) and posts promoting e-liquids with nicotine (40.0%). Promotional strategies and products did not significantly change. The share of posts made by U.S. Instagram users decreased by 11%, although total post volume continued to grow. Conclusions Many e-liquid promotion posts on Instagram remained non-compliant with nicotine warnings after FDA provisions took effect. The large volume of international users also limited the impact of FDA-mandated warnings on the social media environment. Implications Further guidance and enforcement are needed to ensure that U.S. e-liquid marketers on visual social media platforms adhere to current provisions, particularly for individual social media users who are sponsored by industry. The inherently global span of social media also indicates the importance of a shared approach to marketing regulations. Further work is needed to assess enforcement strategies viable for the social media environment.

(1) Background: The heated tobacco product IQOS, by Philip Morris International, is now available in over 55 countries, including the United States. Social media sites such as Twitter are often used to promote or discuss tobacco products, though prior research has not examined how IQOS is presented on Twitter. (2) Methods: This study collected and categorized Twitter conversations involving IQOS. A manual content analysis was performed on N = 3916 English tweets related to IQOS published internationally between 1 January 2020 and 30 June 2020. (3) Results: Most tweets were either online marketing for IQOS (32.3%) or personal testimonials related to IQOS use (34.2%). Personal testimonial tweets made harm reduction claims about IQOS either as an avenue to quit smoking/tobacco use (3.4%), or in comparison to combustible cigarettes (2.0%). Tobacco policy-related tweets were detected (13.9%), split between discussions of United States (4.9%) and international (4.4%) policies. News media tweets (14.2%) were also detected. (4) Conclusions: Our study suggests IQOS may be understood as a less harmful alternative to vaping and combustible cigarettes. Discussions also suggest IQOS is likely to be used to avoid clean air policies or used in areas in which smoking is restricted.