Exposure to user-generated e-cigarette content on social media associated with greater vulnerability to e-cigarette use among youth non-users

Introduction: Social media are important venues for youth 's exposure to e-cigarette content. This study examined how exposure to user-generated e-cigarette content (i.e., content created and shared by individual social media users) is associated with vulnerabilities to e-cigarette use among youth non-users. Methods: We pooled data from the 2021 and 2022 National Youth Tobacco Survey. Youth who have never used ecigarettes were included. Weighted linear and logistic regressions were conducted to examine how exposure to user-generated e-cigarette content (from real-life friends, online-only friends, and celebrities/influencers) on social media was associated with e-cigarette use vulnerabilities measured by perceived norms, perceived risk, and susceptibility of use, controlling for demographics, advertising exposure, and mental health conditions. Multiple imputations were performed to account for missing data. Results: Exposure to e-cigarette content on social media posted by real-life friends, online-only friends, and celebrities/influencers were associated with more positive descriptive norm (8s = 1.56, 0.37, and 0.35, respectively, all p s < .001), more positive injunctive norm (8s = 0.46, 0.19, and 0.10, respectively, all p s < .001), and higher odds of e-cigarette use susceptibility (ORs = 1.48, 1.50. 1.29, respectively, all p s < .001). Exposure to content posted by real-life and online-only friends were associated with reduced risk perception of e-cigarette use (8 = -0.04, p < 0.05 and 8 = -0.07, p < 0.001). Conclusions: Our study highlighted that friends and celebrities/influencers are important sources on social media that can influence youth non-users ' vulnerabilities to e-cigarette use. Interventional messages communicated through friends and influencers on social media may in turn help reduce e-cigarette vulnerability among youth non-users.