Longitudinal associations of tobacco-related social media involvement with cigarette and e-cigarette initiation among US adolescents

Tobacco is the leading cause of preventable morbidity and mortality in the USA. Evidence suggests adolescents are particularly vulnerable to online tobacco marketing. This study examined longitudinal associations of following or liking of tobacco brands with subsequent cigarette and e-cigarette initiation among US adolescents. We used Wave 1-Wave 4 Population Assessment of Tobacco and Health study data (n = 6997) and discrete-time survival regression models to examine associations of past-year tobacco-related social media interactions with the initiation of cigarettes and e-cigarettes among US adolescents. About 4.8% (n = 280) of adolescent never cigarette users and 4.9% (n = 288) of never e-cigarette users followed or liked tobacco brands on social media between Wave 1 and Wave 2. By Wave 4, 8.8% of all cigarettes never users had initiated cigarette use, and 18.7% of never e-cigarette users initiated e-cigarette use. The following or liking tobacco brands on social media was significantly associated with increased odds of cigarette initiation (adjusted odds ratio (aOR) 2.12, 95% CI 1.56-2.88) and e-cigarette initiation (aOR 2.11, 95% CI 1.66-2.69). Also, the initiation of cigarettes and e-cigarettes differed significantly among race/ethnicity, school performance, and other tobacco and substance use. Conclusion: Adolescents who followed or liked tobacco products on social media were more likely to initiate cigarette or e-cigarette use subsequently. Increasing anti-tobacco efforts on social media sites could be beneficial.