Exposure to Cigarette and E-Cigarette-Related Social Media Content and Tobacco Initiation Among Mexican Adolescents
Desiree Vidana-Perez, Inti Barrientos-Gutiérrez, Diego F. Leal, James F. Thrasher, Lizeth Cruz Jimenez, Ana Isabel Rodríguez Guerra, Kevin A. Carson, Edna Arillo-SantillánPURPOSE
To examine whether exposure to tobacco-related social media content predicts initiation of both cigarette and e-cigarette use at follow-up among Mexican adolescents, and to identify correlates of such exposure.
METHODS
Data came from baseline and 6-month follow-up of students in Guadalajara and Tijuana, Mexico. The analytic sample included students (mean age = 15.5 years) with no prior cigarette smoking (n = 3,707) or e-cigarette use (n = 2,948) at baseline. Students reported frequency of exposure to cigarette- and e-cigarette-related content across eight social media platforms (never [ref], monthly, weekly, daily). Covariates included age, sex, city, family affluence, ever cigarette/e-cigarette use, time spent on social media, sensation-seeking, friend use of cigarettes/e-cigarettes, and perceived peer approval. Separate logistic models regressed e-cigarette and cigarette initiation on social media exposures and covariates. Separate multinomial logistic regression models examined correlates of exposure frequency. Robust SEs were clustered at the school level. Results are presented as adjusted odds ratios (AORs) and adjusted relative risk ratios (ARRRs).
RESULTS
Over the 6-month follow-up, 7.3% initiated e-cigarette use and 4.2% initiated cigarette smoking. Most adolescents reported no social media exposure to e-cigarette content (43.3%) or cigarette content (53.2%); 19.3% and 29.3% reported weekly or daily exposure, respectively. In unadjusted models, weekly and daily exposure to e-cigarette- and cigarette-related social media were associated with initiation of both products, but after adjustment, only weekly exposure to e-cigarette-related social media content (vs no exposure) was associated with e-cigarette initiation (AOR = 1.55). Ever use of the other product and higher sensation-seeking scores were associated with e-cigarette initiation (AORs = 3.71 and 1.27) and cigarette smoking initiation (AORs = 3.37 and 1.38). Higher sensation-seeking scores were associated with greater exposure to e-cigarette-related (weekly/daily ARRRs = 1.22/1.51) and cigarette-related content (monthly/weekly/daily ARRRs = 1.09/1.13/1.29). Best friend tobacco use was associated with weekly/daily e-cigarette-related exposure (≥2 friends using e-cigarettes: ARRRs = 1.93/2.77) and weekly/daily cigarette-related exposure (≥2 friends smoking: ARRRs = 1.54/2.32).
CONCLUSION
Exposure to e-cigarette-related social media content increased the risk for e-cigarette initiation among Mexican students. Prior use of either product was strongly associated with initiation of the other product, suggesting shared pathways. Main correlates of tobacco-related social media exposures underscore the roles of individual susceptibility and peer influences in adolescent tobacco use.