![]() We hypothesized that more frequent social media use would be associated with higher levels of susceptibility to e-cigarette use, initiation of, and continued use of e-cigarettes. We used a nationally representative sample of adolescents in the US to examine longitudinal associations between social media use and susceptibility to, initiation of, and continued use of e-cigarettes. Thus, understanding the association between susceptibility to e-cigarette use and continued use of e-cigarettes and social media is critical to fully understanding a wide range of adolescent e-cigarette use behaviors. Examining continued use of e-cigarettes among adolescents who are already using these products is also important because progression to regular use can lead to nicotine addiction and exposure to other toxicants and chemicals (10,11). Understanding susceptibility to use is important because it is an established predictor of e-cigarette use initiation among adolescents (9). Nonetheless, understanding of whether social media use is associated with the full spectrum of e-cigarette use behaviors among adolescents, such as susceptibility to e-cigarette use and continued use of e-cigarettes, is limited. Previous longitudinal studies showed that social media use behaviors, such as exposure to and engagement with tobacco-related content on social media, are associated with e-cigarette initiation among adolescents (7,8). In general, e-cigarettes are positively portrayed on social media as “glamourous,” “healthy,” and “safe” (6). This content may be user-generated, such as a person posting about e-cigarettes to their own social network, or the industry posting marketing content with themes that appeal to adolescents (eg, vape tricks) (3–5). Social media platforms have extensive e-cigarette–related content (2). In 2022, 95% of adolescents aged 13 to 17 years used social media (1). These findings suggest that understanding and addressing the association between social media and e-cigarette use is critical. Our study found that social media use is associated with subsequent susceptibility to e-cigarette use and initiation but not with continued use of e-cigarettes among US adolescents. Among adolescents who ever used e-cigarettes at Wave 4 (n = 794), we found no significant association between social media use at Wave 4 and continued e-cigarette use at Wave 5. ![]() We conducted 2 models: 1) a multinomial logistic regression on e-cigarette use susceptibility and use behaviors at Wave 5 by social media use at Wave 4 among adolescents who never used e-cigarettes at Wave 4 and 2) a binomial logistic regression on current e-cigarette use at Wave 5 by social media use at Wave 4 among adolescents who ever used e-cigarettes at Wave 4.Īmong adolescents who never used e-cigarettes at Wave 4 (n = 7,872), daily social media use (vs never) was associated with a higher likelihood of being susceptible to e-cigarette use (adjusted odds ratio =1.46 95% CI, 1.20–1.78), past e-cigarette use (aOR = 3.55 95% CI, 2.49–5.06), and current e-cigarette use (aOR = 3.45 95% CI, 2.38–5.02) at Wave 5. We used data on adolescents participating in the Population Assessment of Tobacco and Health (PATH) Study Wave 4 (2016–2018) and Wave 5 (2018–2019). We analyzed national data on US adolescents to assess these associations. Little is known about the associations between social media use and a wide range of e-cigarette use behaviors, including susceptibility, initiation, and continued use. Social media has a large amount of e-cigarette content. Preventing adolescent exposure to e-cigarette content on social media is important. ![]() What are the implications for public health practice? Use of social media among adolescents is associated with being susceptible to and initiating e-cigarette use in subsequent years. The prevalence of social media use among adolescents is high, and social media has extensive e-cigarette content.
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