Social media use, brand engagement, and tobacco product initiation among youth: Evidence from a prospective cohort study

Objective: To evaluate whether frequent social media use and liking/following tobacco brand accounts was associated with increased risk of tobacco and polytobacco initiation over approximately 1-year follow-up among youth with no prior tobacco use. Methods: Associations between measures of social media engagement (daily social media use and liking/following tobacco brands) and tobacco initiation risk were examined using data from Waves 2 and 3 (2014–2015) of the US Population Assessment for Tobacco and Health study. Separate log-binomial models, accounting for missing data via multiple imputation and using propensity score adjustment to address confounding, estimated the adjusted relative risk (aRR) of any tobacco initiation and poly-use (2 + products) initiation at 1-year follow-up. Results: Among the 8,672 youth with no prior tobacco use (49.3% female, mean [SD] age 14.1 [1.7]), 63.5% used social media at least daily, and 3.3% reported liking/following ≥ 1 tobacco brands on social media. Those reporting daily or more frequent social media use (compared to less) were at increased risk for tobacco (aRR 1.67; 95% CI 1.38–2.02) and polytobacco initiation (aRR 1.32; 95% CI 0.98–1.78). Although results were imprecise, liking/following ≥ 1 tobacco brands on social media (versus none) was associated with tobacco (aRR 1.34; 95% CI 0.95–1.89) or polytobacco initiation (aRR 1.60; 95% CI 0.99–2.60). In sensitivity analyses, liking/following cigarette or cigarillo brands was associated with polytobacco initiation. Conclusions: This study adds to a growing evidence-base describing the exposure of youth to tobacco-related social media content. Such content—often generated by tobacco companies—may contribute to youth tobacco initiation.