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Cited by 42Smoking Behavior and CessationImpact of Technology on AdolescentsGlobal Public Health Policies and Epidemiology

Youth’s Exposure to and Engagement with E-Cigarette Marketing on Social Media: A UK Focus Group Study

Open access
Smith, Marissa J, Hilton, Shona·2023·BMJ Open
DOI 10.1136/bmjopen-2022-071270PMC PMC10450076
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Abstract

Objective: Electronic-cigarettes (e-cigarette) are promoted creatively through social media and considering the potential influence of social media marketing on young people, we explored young people’s exposure to and engagement with social media marketing of e-cigarettes. Design: Semistructured discussion groups. Subjects: Twenty focus groups with 82 young people aged 11–16 living in the Central belt of Scotland. Methods: Youths were asked about smoking and vaping behaviours, social media use, vaping advertisement exposure and were shown illustrative examples of social media content (eg, images and videos) about different messages, presentations and contextual features. Transcripts were imported into NVivo V.12, coded thematically and analysed. Results: Youths highlighted a variety of tactics e-cigarette companies use, including influencer or celebrity endorsement, attractive youth flavours, bright colours and emotional appeal to advertise and promote their products directly to young people. Social media influencers who advertise e-cigarettes were described as portraying e-cigarettes as ‘cool’ and ‘fashionable’ to entice viewers to try the products. Youths considered that there is a need for more restrictions on social media content to protect youths while also still allowing smokers to purchase them as a cessation device. Conclusions: Our study highlights that the e-cigarette industry is using previously employed tactics similar to the tobacco industry to advertise and promote its products on social media. These findings suggest the growing need for governments to work together to develop and implement policies to restrict the advertising and marketing of e-cigarettes on social media.

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  • The widespread availability of marketing for flavored electronic cigarettes has fueled an epidemic of vaping and led to dual consumption of cigarettes and vapes among adolescents.

    “The widespread availability of marketing for flavored electronic cigarettes has fueled an epidemic of vaping, which has also led to a troubling trend of dual consumption—both cigarettes and vapes—among adolescents.”

    From Mobilizing for Health: A Case Study of Kazakhstan’s Vaping Ban Advocacy Campaign (2025) · cites this paper as [14]

    The Introduction (page not provided) links e-cigarette marketing to increased vaping among youths, and the Results describe sweet and fruity flavours as appealing to them. But the paper does not establish that this marketing fueled an epidemic or caused adolescents to use both cigarettes and vapes; it identifies dual-users as an understudied group. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Several studies indicate that the dual consumption trend is contributing to an increase in cigarette smoking among young people.

    “Several studies have indicated that this trend is contributing to an increase in cigarette smoking among young people [13,14,15].”

    From Mobilizing for Health: A Case Study of Kazakhstan’s Vaping Ban Advocacy Campaign (2025) · cites this paper as [14]

    The Introduction (page unavailable) defines dual-users as people who use both cigarettes and e-cigarettes, but says they are understudied. The Discussion and Conclusion address e-cigarette marketing and youth vaping; no passage found says dual use is contributing to increased cigarette smoking among young people (searched for dual use and smoking increases). (LLM, conf=0.76)

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Research works printed but not linked: 59

  1. [1]Hammond D, Wackowski OA, Reid JL, et al. Use of JUUL E-cigarettes among youth in the United States. Nicotine Tob Res 2020; 22: 827– 32. 10.1093/ntr/nty237 30371838 PMC7171277 · DOI
  2. [2]Duke JC, Allen JA, Eggers ME, et al. Exploring differences in youth perceptions of the effectiveness of electronic cigarette television advertisements. Nicotine Tob Res 2016; 18: 1382– 6. 10.1093/ntr/ntv264 26706908 · DOI
  3. [3]Farrelly MC, Duke JC, Crankshaw EC, et al. A randomized trial of the effect of E-cigarette TV advertisements on intentions to use E-cigarettes. Am J Prev Med 2015; 49: 686– 93. 10.1016/j.amepre.2015.05.010 26163170 · DOI
  4. [4]Hammond D, Reid JL, Burkhalter R, et al. E-cigarette marketing regulations and youth Vaping: cross-sectional surveys. Pediatrics 2020; 146. 10.1542/peds.2019-4020 PMC7329261 32601126 · DOI
  5. [7]Stead M, Ford A, Angus K, et al. E-cigarette advertising in the UK: A content analysis of traditional and social media advertising to observe compliance with current regulations. Nicotine Tob Res 2021; 23: 1839– 47. 10.1093/ntr/ntab075 33856487 PMC8496471 · DOI
  6. [11]O’Brien EK, Hoffman L, Navarro MA, et al. Social media use by leading US E-cigarette, cigarette, Smokeless tobacco, cigar and hookah brands. Tob Control 2020; 29: e87– 97. 10.1136/tobaccocontrol-2019-055406 32217772 PMC13019466 · DOI
  7. [12]De Veirman M, Hudders L, Nelson MR. What is Influencer marketing and how does it target children? A review and direction for future research. Front Psychol 2019; 10: 2685. 10.3389/fpsyg.2019.02685 31849783 PMC6901676 · DOI
  8. [13]Zhu S-H, Sun JY, Bonnevie E, et al. Four hundred and sixty brands of E-cigarettes and counting: implications for product regulation. Tob Control 2014; 23: iii3– 9. 10.1136/tobaccocontrol-2014-051670 24935895 PMC4078673 · DOI
  9. [14]Smith MJ, Buckton C, Patterson C, et al. User-generated content and Influencer marketing involving E-cigarettes on social media: a Scoping review and content analysis of Youtube and Instagram. BMC Public Health 2023; 23: 530. 10.1186/s12889-023-15389-1 36941553 PMC10029293 · DOI
  10. [15]Chu K-H, Colditz JB, Primack BA, et al. JUUL: spreading online and Offline. J Adolesc Health 2018; 63: 582– 6. 10.1016/j.jadohealth.2018.08.002 30348280 PMC6201306 · DOI
  11. [16]Phua J, Jin SV, Hahm JM. Celebrity-endorsed E-cigarette brand Instagram advertisements: effects on young adults’ attitudes towards E-cigarettes and smoking intentions. J Health Psychol 2018; 23: 550– 60. 10.1177/1359105317693912 28810409 · DOI
  12. [17]Amin S, Dunn AG, Laranjo L. Social influence in the uptake and use of electronic cigarettes: A systematic review. Am J Prev Med 2020; 58: 129– 41. 10.1016/j.amepre.2019.08.023 31761515 · DOI
  13. [18]de Andrade M, Hastings G, Angus K. Promotion of electronic cigarettes: tobacco marketing reinvented? BMJ 2013; 347: bmj.f7473. 10.1136/bmj.f7473 24361526 · DOI
  14. [19]Fairchild AL, Bayer R, Colgrove J. The Renormalization of smoking? E-cigarettes and the tobacco “Endgame N Engl J Med 2014; 370: 293– 5. 10.1056/NEJMp1313940 24350902 · DOI
  15. [20]Schneider S, Diehl K. Vaping as a catalyst for smoking? an initial model on the initiation of electronic cigarette use and the transition to tobacco smoking among adolescents. Nicotine Tob Res 2016; 18: 647– 53. 10.1093/ntr/ntv193 26386472 · DOI
  16. [21]Etter J-F. Gateway effects and electronic cigarettes. Addiction 2018; 113: 1776– 83. 10.1111/add.13924 28786147 · DOI
  17. [22]Cobb NK, Brookover J, Cobb CO. Forensic analysis of online marketing for electronic nicotine delivery systems. Tob Control 2015; 24: 128– 31. 10.1136/tobaccocontrol-2013-051185 24038037 · DOI
  18. [23]Amin S, Dunn AG, Laranjo L. Exposure to E-cigarette information and advertising in social media and E-cigarette use in Australia: A mixed methods study. Drug Alcohol Depend 2020; 213: 108112. 10.1016/j.drugalcdep.2020.108112 32574981 · DOI
  19. [24]Prochaska JJ, Pechmann C, Kim R, et al. An analysis of Twitter quit smoking social networks. Tob Control 2012; 21: 447– 9. 10.1136/tc.2010.042507 21730101 PMC3310933 · DOI
  20. [25]Chen Y, Tilden C, Vernberg DK. Adolescents' interpretations of E-cigarette advertising and their engagement with E-cigarette information: results from five focus groups. Psychol Health 2020; 35: 163– 76. 10.1080/08870446.2019.1652752 31418593 · DOI
  21. [26]Scheffels J, Tokle R, Linnansaari A, et al. E-cigarette use in global Digital youth culture. A qualitative study of the social practices and meaning of Vaping among 15-20-year-olds in Denmark. Int J Drug Policy 2023; 111: 103928. 10.1016/j.drugpo.2022.103928 36527908 · DOI
  22. [27]Johnson AC, Mays D, Hawkins KB, et al. A qualitative study of adolescent perceptions of electronic cigarettes and their marketing: implications for prevention and policy. Child Health Care 2017; 46: 379– 92. 10.1080/02739615.2016.1227937 30899129 PMC6424501 · DOI
  23. [28]Liu J, McLaughlin S, Lazaro A, et al. What does it meme? A qualitative analysis of adolescents' perceptions of tobacco and marijuana Messaging. Public Health Rep 2020; 135: 578– 86. 10.1177/0033354920947399 32791026 PMC7485045 · DOI
  24. [29]Pepper JK, McRee AL, Gilkey MB. Healthcare providers' beliefs and attitudes about electronic cigarettes and preventive counseling for adolescent patients. J Adolesc Health 2014; 54: 678– 83. 10.1016/j.jadohealth.2013.10.001 24332394 PMC4111908 · DOI
  25. [30]Smith MJ, MacKintosh AM, Ford A, et al. Youth’s engagement and perceptions of disposable E-cigarettes: a UK focus group study. BMJ Open 2023; 13: e068466. 10.1136/bmjopen-2022-068466 PMC10040067 36948552 · DOI
  26. [31]Guest G, Bunce A, Johnson L. How many interviews are Enough?:An experiment with data saturation and variability. 2006; 18: 59– 82. 10.1177/1525822X05279903 · DOI · Paper page
  27. [34]Ge J. Emoji sequence use in enacting personal identity. Liu L, White R, eds. WWW ’19; San Francisco USA. New York, NY, USA, May 13, 2019: 426– 38 10.1145/3308560.3316545 · DOI
  28. [35]Ge J, Gretzel U. Emoji rhetoric: a social media Influencer perspective. J Market Manage 2018; 34: 1272– 95. 10.1080/0267257X.2018.1483960 · DOI
  29. [36]Jacobson J, Hodson J, Mittelman R. Pup-Ularity contest: the advertising practices of popular animal Influencers on Instagram. Technological Forecasting and Social Change 2022; 174: 121226. 10.1016/j.techfore.2021.121226 · DOI
  30. [37]Kostygina G, Tran H, Czaplicki L, et al. Developing a theoretical marketing framework to analyse JUUL and compatible E-cigarette product promotion on Instagram. Tob Control 2023; 32: e192– 7. 10.1136/tobaccocontrol-2021-057120 35190395 PMC9942712 · DOI
  31. [38]Alpert JM, Jaisle A, Chen H. A content analysis of the promotional strategies employed by E-cigarette brands on Twitter. Health Marketing Quarterly 2019; 36: 307– 21. 10.1080/07359683.2019.1680121 31696789 · DOI
  32. [39]Struik LL, Dow-Fleisner S, Belliveau M, et al. Tactics for drawing youth to Vaping: content analysis of electronic cigarette advertisements. J Med Internet Res 2020; 22: e18943. 10.2196/18943 32663163 PMC7455879 · DOI
  33. [40]Malik A, Li Y, Karbasian H, et al. User and content analysis of Twitter posts about Juul. Am J Health Behav 2019; 43: 326– 36. 10.5993/AJHB.43.2.9 30808472 · DOI
  34. [41]Allem J-P, Dharmapuri L, Unger JB, et al. Characterizing JUUL-related posts on Twitter. Drug Alcohol Depend 2018; 190: 1– 5. 10.1016/j.drugalcdep.2018.05.018 29958115 PMC6693487 · DOI
  35. [42]Cole-Lewis H, Pugatch J, Sanders A, et al. Social listening: A content analysis of E-cigarette discussions on Twitter. J Med Internet Res 2015; 17: e243. 10.2196/jmir.4969 26508089 PMC4642379 · DOI
  36. [43]Ketonen V, Malik A. Characterizing Vaping posts on Instagram by using Unsupervised machine learning. Int J Med Inform 2020; 141: S1386-5056(20)30488-3. 10.1016/j.ijmedinf.2020.104223 32623330 · DOI
  37. [44]Smith MJ, Buckton C, Patterson C, et al. n.d. A Scoping review and content analysis of Youtube and Instagram posts. PMC10029293 36941553
  38. [45]de Andrade M, Angus K, Hastings G. Teenage perceptions of electronic cigarettes in Scottish tobacco-education school interventions: Co-production and innovative engagement through a pop-up radio project. Perspect Public Health 2016; 136: 288– 93. 10.1177/1757913915612109 26543156 · DOI
  39. [46]Choi K, Fabian L, Mottey N, et al. Young adults' favorable perceptions of Snus, Dissolvable tobacco products, and electronic cigarettes: findings from a focus group study. Am J Public Health 2012; 102: 2088– 93. 10.2105/AJPH.2011.300525 22813086 PMC3469759 · DOI
  40. [47]Park E, Kwon M, Gaughan MR, et al. Listening to adolescents: their perceptions and information sources about E-cigarettes. J Pediatr Nurs 2019; 48: 82– 91. 10.1016/j.pedn.2019.07.010 31362205 · DOI
  41. [48]Vogel EA, Ramo DE, Rubinstein ML, et al. Effects of social media on adolescents’ willingness and intention to use E-cigarettes: an experimental investigation. Nicotine Tob Res 2020; 10: 1093/ntr/ntaa003. PMC7976937 31912147
  42. [49]Vassey J, Valente T, Barker J, et al. E-cigarette brands and social media Influencers on Instagram: a social network analysis. Tob Control 2023; 32: e184– 91. 10.1136/tobaccocontrol-2021-057053 35131947 PMC9473311 · DOI
  43. [50]Dewhirst T. Co-Optation of harm reduction by big tobacco. Tob Control 2021; 30: e1– 3. 10.1136/tobaccocontrol-2020-056059 32796080 · DOI
  44. [51]Prakash S, Xu Y, Goldenson NI, et al. Transitions in smoking among adults newly purchasing the JUUL system. Am J Health Behav 2021; 45: 546– 62. 10.5993/AJHB.45.3.9 33894799 · DOI
  45. [52]Wayne GF, Connolly GN. How cigarette design can affect youth initiation into smoking: Camel cigarettes 1983-93. Tob Control 2002; 11: I32– 9. 10.1136/tc.11.suppl_1.i32 11893812 PMC1766065 · DOI
  46. [53]Carpenter CM, Wayne GF, Connolly GN. Designing cigarettes for women: new findings from the tobacco industry documents. Addiction 2005; 100: 837– 51. 10.1111/j.1360-0443.2005.01072.x 15918814 · DOI
  47. [54]Anderson SJ, Glantz SA, Ling PM. Emotions for sale: cigarette advertising and women’s Psychosocial needs. Tob Control 2005; 14: 127– 35. 10.1136/tc.2004.009076 15791023 PMC1748016 · DOI
  48. [57]Walley SC, Wilson KM, Winickoff JP, et al. A public health crisis: electronic cigarettes. Pediatrics 2019; 143. 10.1542/peds.2018-2741 31122947 · DOI
  49. [58]Kong G, Morean ME, Cavallo DA, et al. Reasons for electronic cigarette experimentation and discontinuation among adolescents and young adults. Nicotine Tob Res 2015; 17: 847– 54. 10.1093/ntr/ntu257 25481917 PMC4674436 · DOI
  50. [59]Audrain-McGovern J, Strasser AA, Wileyto EP. The impact of flavoring on the rewarding and reinforcing value of E-cigarettes with nicotine among young adult Smokers. Drug Alcohol Depend 2016; 166: 263– 7. 10.1016/j.drugalcdep.2016.06.030 27426010 PMC4995771 · DOI
  51. [60]Czoli CD, Goniewicz M, Islam T, et al. Consumer preferences for electronic cigarettes: results from a discrete choice experiment. Tob Control 2016; 25: e30– 6. 10.1136/tobaccocontrol-2015-052422 26490845 · DOI
  52. [61]Zare S, Nemati M, Zheng Y, et al. A systematic review of consumer preference for E-cigarette attributes: flavor, nicotine strength, and type. PLoS ONE 2018; 13: e0194145. 10.1371/journal.pone.0194145 29543907 PMC5854347 · DOI
  53. [63]Okawa S, Tabuchi T, Miyashiro I. Who uses E-cigarettes and why? E-cigarette use among older adolescents and young adults in Japan: JASTIS study. J Psychoactive Drugs 2020; 52: 37– 45. 10.1080/02791072.2019.1708999 31888424 · DOI
  54. [64]Cranwell J, Murray R, Lewis S, et al. Adolescents' exposure to tobacco and alcohol content in Youtube music videos. Addiction 2015; 110: 703– 11. 10.1111/add.12835 25516167 PMC4402034 · DOI
  55. [65]Williams RS, Derrick J, Ribisl KM. Electronic cigarette sales to minors via the Internet. JAMA Pediatr 2015; 169: e1563. 10.1001/jamapediatrics.2015.63 25730697 PMC4408777 · DOI
  56. [66]Schiff S, Liu F, Cruz TB, et al. E-cigarette and cigarette purchasing among young adults before and after implementation of California’s tobacco 21 policy. Tob Control 2021; 30: 206– 11. 10.1136/tobaccocontrol-2019-055417 32108084 PMC8260105 · DOI
  57. [67]Pike JR, Tan N, Miller S, et al. The effect of E-cigarette commercials on youth smoking: A prospective study. Am j Health Behav 2019; 43: 1103– 18. 10.5993/AJHB.43.6.8 31662169 PMC6824286 · DOI
  58. [71]Depue JB, Southwell BG, Betzner AE, et al. Encoded exposure to tobacco use in social media predicts subsequent smoking behavior. Am J Health Promot 2015; 29: 259– 61. 10.4278/ajhp.130214-ARB-69 24670071 · DOI
  59. [72]Hébert ET, Case KR, Kelder SH, et al. Exposure and engagement with Tobacco- and E-cigarette-related social media. J Adolesc Health 2017; 61: 371– 7. 10.1016/j.jadohealth.2017.04.003 28669801 PMC5572318 · DOI

Cited by

Sorted by citations

Authors
Smith, M. J., & Hilton, S.
Affiliations
MRC/CSO Social and Public Health Sciences Unit (GB)
Corresponding author
Smith, Marissa J
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2023-08
Volume
13
Issue
8
Pages
e071270
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2022-071270
PMC
PMC10450076
OpenAlex
W4386102116
Cited by
42
References
1
Citations by year
2026: 11 · 2025: 21 · 2024: 10
FWCI
7.46
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
  • Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Cancer Research UK (PPRCTAGPJT\100003)
  • Medical Research Council (MC_UU_00022/1)
  • Chief Scientist Office of the Scottish Government (SPHSU17)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Global Public Health Policies and Epidemiology
Keywords
electronic cigarettes, social media marketing, adolescent engagement, influencer endorsement, emotional appeal, tobacco industry tactics, vaping, advertising restrictions, smoking cessation
MeSH terms
Adolescent, Humans, Scotland, Focus Groups, Tobacco Industry, Marketing, Social Media, Electronic Nicotine Delivery Systems

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