Negative Perceptions of Young People Using E-cigarettes on Instagram: An Experiment with Adolescents.

BACKGROUND Although e-cigarette marketing on social media increases positive attitudes and experimentation, little is known about non-influencer e-cigarette portrayals of young people. METHODS High school adolescents (n=928, 15-18) were recruited by Lightspeed Health for an online experiment and randomized to view an Instagram post with or without e-cigarette use. Outcomes were positive and negative perceptions (prototypes), social distance, and willingness to use. RESULTS Half (50%) of participants were susceptible to e-cigarette use. E-cigarettes shown (vs. not) led to less positive prototypes, p=.017, more negative prototypes, p=.004, and more social distance, p<.001. Negative prototypes and social distance were moderated by susceptibility (both p<.05); effects among non-susceptible adolescents only. Showing e-cigarettes did not impact willingness to use if offered. DISCUSSION Negative perceptions of e-cigarettes use challenge assumptions that vaping online is universally admirable. Highlighting unfavorable opinions of vaping or negative impacts for adolescents' social image are potential strategies for tobacco counter-marketing. IMPLICATIONS Despite daily use of visual-based social media by most adolescents, little is known about the influence of e-cigarette use among young people online. Adolescent negative perceptions and desired distance from non-influencers using e-cigarettes on Instagram indicate digital e-cigarette portrayals are not universally accepted. Negative impacts for adolescents' social image present a counter-marketing strategy.