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- Title
Health Warnings on Instagram Advertisements for Synthetic Nicotine E-Cigarettes and Engagement.
- Authors
Wu, Jiaxi; Trifiro, Briana M.; Ranker, Lynsie R.; Origgi, Juan Manuel; Benjamin, Emelia J.; Robertson, Rose Marie; Bhatnagar, Aruni; Stokes, Andrew C.; Xuan, Ziming; Wijaya, Derry; Plummer, Bryan; Cornacchione Ross, Jennifer; Fetterman, Jessica L.; Hong, Traci
- Abstract
Key Points: Question: Do synthetic nicotine brands adhere to the Food and Drug Administration (FDA) guidelines for tobacco marketing, and how is the presence of a health warning associated with user engagement on Instagram? Findings: In this cross-sectional study of 2071 Instagram posts for 25 synthetic nicotine brands, only 263 posts (13%) adhered to FDA health warning requirements. Posts advertising flavored products received more likes and comments, and those with health warnings received fewer comments, indicating that compliance with FDA guidelines reduces user engagement. Meaning: These findings suggest that enforcing FDA-compliant health warnings on social media posts of synthetic nicotine products may reduce youth engagement with tobacco marketing on social media. This cross-sectional study examines whether synthetic nicotine e-cigarette brands implemented Food and Drug Administration health warning requirements and evaluates the association between health warnings and user engagement on Instagram. Importance: Synthetic nicotine is increasingly used in e-cigarette liquids along with flavors to appeal to youths. Regulatory loopholes have allowed tobacco manufacturers to use social media to target youths. Objective: To analyze the extent to which synthetic nicotine e-cigarette brands have implemented US Food and Drug Administration (FDA) health warning requirements and to evaluate the association between health warnings and user engagement on Instagram. Design, Setting, and Participants: In this cross-sectional study, posts from 25 brands were analyzed across a 14-month period (August 2021 to October 2022). A content analysis was paired with Warning Label Multi-Layer Image Identification, a computer vision algorithm designed to detect the presence of health warnings and whether the detected health warning complied with FDA guidelines by (1) appearing on the upper portion of the advertisement and (2) occupying at least 20% of the advertisement's area. Data analysis was performed from March to June 2024. Exposure: Synthetic nicotine e-cigarette advertisement on Instagram. Main Outcomes and Measures: The outcome variables were user engagement (number of likes and comments). Negative binomial regression analyses were used to evaluate the association between the presence and characteristics of health warnings and user engagement. Results: Of a total of 2071 posts, only 263 (13%) complied with both FDA health warning requirements. Among 924 posts with health warnings, 732 (79%) displayed warnings in the upper image portion, and 270 (29%) had a warning covering at least 20% of the pixel area. Posts with warnings received fewer comments than posts without warnings (mean [SD], 1.8 [2.5] vs 5.4 [11.7] comments; adjusted incident rate ratio [aIRR], 0.70; 95% CI, 0.57-0.86; P <.001). For posts containing warnings, a larger percentage of the warning label's pixel area was associated with fewer comments (aIRR, 0.96; 95% CI, 0.93-0.99; P =.003). Flavored posts with health warnings placed in the upper image portion received more likes than posts with warnings in the lower portion (mean [SD], 34.6 [35.2] vs 19.9 [19.2] likes; aIRR, 1.48; 95% CI, 1.07-2.06; P =.02). Conclusions and Relevance: In this cross-sectional study of synthetic nicotine brand Instagram accounts, 87% of sampled posts did not adhere to FDA health warning requirements in tobacco promotions. Enforcement of FDA compliant health warnings on social media may reduce youth engagement with tobacco marketing.
- Subjects
UNITED States; LABELING laws; SOCIAL media; CROSS-sectional method; POISSON distribution; RESEARCH funding; ADOLESCENT health; ELECTRONIC cigarettes; CONTENT analysis; NICOTINE; UNITED States. Food &; Drug Administration; DESCRIPTIVE statistics; ADVERTISING; BUSINESS; DATA analysis software; CONFIDENCE intervals; REGRESSION analysis; GOVERNMENT regulation
- Publication
JAMA Network Open, 2024, Vol 7, Issue 9, pe2434434
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.34434