General Medicine · Medical Literature
Evaluating strategies to reduce the effects of pro-e-cigarette social media posts in young adults.
Abstract
Examine how sponsorship disclosures and nicotine warning labels (NWLs) affect responses to proe-cigarette Instagram posts among Mexican young adults. In a 2 x 2 online experiment, Mexicans aged 18-24 (N= 699; 53% users and 47% nonusers of cigarettes or e-cigarettes who were susceptible to future use) were randomly assigned to view one of four Instagram posts: 1) control, 2) disclosure-only, 3) NWL-only, or 4) combination. Participants reported susceptibility to e-cigarettes, positive expectancies, and risk perceptions. Outcomes were analyzed via logistic regression (ref=control). Compared to the control, participants exposed to the NWL alone or combined were less likely to be curious to try the e-cigarette (OR= 0.54, 95%CI 0.35,0.83; OR= 0.54, 95%CI 0.34,0.84), try it if offered by a friend (OR= 0.59, 95%CI 0.39,0.90; OR= 0.55, 95%CI 0.36,0.85), or expect to enjoy use (OR= 0.64, 95%CI 0.42,0.97; OR= 0.65, 95%CI 0.43,1.00). Risk perceptions did not differ; disclosures had no effect. The disclosure-only condition (vs control) increased willingness to try e-cigarettes among people who currently smoked or were susceptible to smoking (β= 0.84, p <0.05). NWLs, but not sponsorship disclosures, reduce Mexican youth susceptibility and positive expectancies toward e-cigarettes.
Clinical relevance
E-cigarette use among young adults in Mexico represents a growing public health concern, particularly given the proliferation of pro-e-cigarette content on social media platforms such as Instagram. This study addresses a critical regulatory and communications gap by experimentally testing whether point-of-exposure label interventions—sponsorship disclosures and nicotine warning labels (NWLs)—can mitigate the persuasive effects of e-cigarette marketing on susceptible Mexican youth aged 18–24. Clinicians and public health practitioners working in tobacco cessation, adolescent medicine, and health policy should attend to these findings as Latin American nations consider evidence-based digital advertising regulations.
Key findings
1. Participants exposed to NWL-only (vs. control) were significantly less likely to report curiosity to try an e-cigarette (OR=0.54, 95% CI 0.35–0.83), indicating approximately a 46% reduction in odds of curiosity. 2. Participants exposed to the combination condition (NWL + disclosure) similarly showed reduced curiosity to try e-cigarettes (OR=0.54, 95% CI 0.34–0.84), suggesting no meaningful additive benefit of combining disclosures with NWLs over NWLs alone. 3. Both NWL-only and combination conditions significantly reduced willingness to try the e-cigarette if offered by a friend compared to control (OR=0.59, 95% CI 0.39–0.90; OR=0.55, 95% CI 0.36–0.85, respectively). 4. Positive expectancies (expecting to enjoy use) were significantly lower in both NWL-only and combination groups versus control (OR=0.64, 95% CI 0.42–0.97; OR=0.65, 95% CI 0.43–1.00, respectively). 5. Risk perceptions did not differ significantly across any condition, suggesting NWLs reduce appeal and positive expectancies without measurably elevating perceived risk in this population. 6. Sponsorship disclosure alone had no protective effect and, notably, increased willingness to try e-cigarettes among current smokers or smoking-susceptible participants versus control (β=0.84, p<0.05), indicating a potential iatrogenic effect in high-risk subgroups.
Practice implications
Public health clinicians and policymakers should advocate for mandatory nicotine warning labels on social media e-cigarette advertisements targeting young adults, as NWLs—whether alone or combined with sponsorship disclosures—demonstrably reduce susceptibility and positive expectancies in this population. Sponsorship disclosures alone should not be relied upon as a harm-reduction strategy and may paradoxically increase e-cigarette trial intent among current or susceptible smokers, warranting caution in their implementation without accompanying NWLs. These findings support the prioritization of NWL-inclusive digital advertising regulations in Mexico and analogous Latin American contexts, and clinicians counseling young adult patients about e-cigarette risks should be aware that disclosure-based literacy interventions alone are insufficient to counter pro-e-cigarette social media influence.