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Social media and E-cigarette use among US youth: Longitudinal evidence on the role of online advertisement exposure and risk perception

Highlights•We examined the link between social media use and e-cigarette use among U.S. youth.•E-cigarette advertisement exposure and risk perception serially mediated the link.•Social media use predicted incidental e-cigarette advertisement exposure.•E-cigarette advertisement exposure predicted lower risk perception of e-cigarette.•Lower risk perception of e-cigarette predicted e-cigarette use.AbstractObjectivesPrevious studies revealed a link between social media use and e-cigarette use among U.S. youth, but less is known about the mechanisms through which they interconnect. This study examined how social media and e-cigarette use are connected through online advertisement exposure and risk perception of e-cigarettes among U.S. youth.MethodsYouth aged 12–17 from the Public Assessment of Tobacco and Health (PATH) Study Waves 2–4 (2014–2018) were included (N = 6,208). This study integrated the incidental exposure framework and the risk perception framework to guide study conceptualization and variable selection. Generalized structural equation modeling was performed to investigate the sequential mediation relationship between social media and e-cigarette use through online e-cigarette advertisement exposure and risk perception of e-cigarette use.ResultsYouth respondents with more social media use were more likely to be exposed to e-cigarette advertisement at Wave 2 (OR = 1.13, p < 0.001), which led to lower e-cigarette risk perception at Wave 3 (β = -0.07, p < 0.001). Higher e-cigarette risk perception at Wave 3 resulted in lower likelihood of e-cigarette use at Wave 4 (OR = 0.57, p < 0.001). High social media use at Wave 2 was directly associated with high likelihood of e-cigarette use at Wave 4 (OR = 1.11, p < 0.001).ConclusionsThe results indicate that social media use is associated with increased e-cigarette use through online e-cigarette advertisement exposure and subsequently decreased e-cigarette risk perception among U.S. youth. Our findings underscore the importance of regulating online e-cigarette advertisement, with the emphasis of avoiding information that could twist youth’s risk perception of e-cigarettes, which may in turn curtail youth e-cigarette use.


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