How Does Online e-cigarette Advertisement Promote Youth’s e-cigarettes Use? The Mediating Roles of Social Norm and Risk Perceptions

ABSTRACT

The adoption of the internet, social media, and e-cigarettes are on the rise among U.S. youth. Uses of social media and online platforms increase the probability for youth to encounter e-cigarette advertisements. Departing from this line of reasoning, we examine the underlying mechanisms of how online e-cigarettes exposure promotes youth’s e-cigarette use. Drawing on insights from the social construction of risk model, this study looks at how perceived social norms and risk perception mediate the link between online e-cigarette advertisement exposure and e-cigarette use. Youth aged 12–17 from the Public Assessment of Tobacco and Health (PATH) Study Waves 2–4 (2014–2018) were included (N = 6,067). Controlling for demographic and other known risk factors for e-cigarette use, respondents who had been exposed to online e-cigarette ads at Wave 2 perceived higher levels of positive social norms of e-cigarette use at Wave 3 (β = 0.13, p < .001) which was associated with lower e-cigarette risk perception at Wave 3 (β = −0.22, p < .001). Lower e-cigarette risk perception at Wave 3 resulted in a higher likelihood of e-cigarette use at Wave 4 (AOR = 0.51, p < .001). Online e-cigarettes ads exposure at Wave 2 predicted e-cigarette use at Wave 4 (AOR = 1.87, p < .001). The results indicate that norm perception associated with online e-cigarettes ads may twist youth’s e-cigarette risk perception that is associated with subsequent usage. Interventions to curb youth’s e-cigarette use can target social norms of e-cigarette use and restrict e-cigarette advertisement exposure to youth.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. We also included an alternative model with two separate social norm items. The two items have the same effect regarding direction of association and statistical significance. Please see Figure A1 in the appendix (https://osf.io/fc2b5).

2. We conducted sensitivity analysis by considering alternative models with additional control variables or paths. The main results remain the same (in terms of direction of influence and significance of results). Alternative models can be found in the online appendix (https://osf.io/fc2b5).

Additional information

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.