Teens Routinely Exposed to Banned e-Cig Promos on Instagram

Adolescents are routinely exposed to promotional content for e-cigarettes and vaping products on Instagram, which is in violation of regulatory policies.

In a study, researchers found that the majority of Instagram posts related to e-cigarettes, vaping products, and other electronic nicotine delivery systems (ENDSs) are marketed to youth, violating federal regulations and Instagram’s branded content policy regarding prohibited content. 

These results “point to the need for better enforcement of FDA regulations and Instagram content policies to minimize youth exposure to promotional content,” Jessica Tran, fourth-year medical student at the University of Texas Medical Branch, Galveston, Texas, said during a press briefing. 

Tran presented the findings ( Abstract P04-006) on May 4 at the American Psychiatric Association (APA) 2024 Annual Meeting.

Targeting Teens

Exposure to e-cigarettes, vaping products, and other ENDSs via social media has been linked to increased use, with more than 2.1 million youths currently using e-cigarettes and more than 1 in 4 using these products daily.

As of 2018, the US Food and Drug Administration (FDA) has required that all tobacco products, including ENDSs, are to include a warning stating that the product contains the addictive substance nicotine. 

Following that, in 2019, Instagram has prohibited branded content that promotes vaporizers, e-cigarettes, and any other products that simulate smoking. 

But Tran and her colleagues found holes in compliance. 

They queried ENDS-related Instagram posts in December 2023 by using a sham Instagram profile for a 14-year-old girl in an incognito web browser and posting with these hashtags: “#vaping #vapelife #vapestagram #vapefam #eliquid #ejuice #ecig #vapenation #vapelyfe and #vapecommunity.”

They selected the top 27 publicly available posts from each hashtag, yielding a total of 270 posts. After exclusion of duplicate or unrelated posts, they analyzed a total of 51 ENDS-related posts.

Roughly two thirds of posts (67%) had a positive portrayal of e-cigarette use, and only about 1 in 4 posts (24%) had a negative portrayal; about 10% of posts were neutral. More than half of the posts (59%) were promotional, and only 26% were educational. 

Nearly half of posts were shared by vape ambassadors, influencers with 10,000+ followers, or vape shops, thus violating Instagram’s branded content policy.

Two thirds of posts did not contain warnings regarding age restriction or the addictive potential of nicotine, violating FDA regulations. 

Need for Accurate Health Info 

Briefing moderator Howard Liu, MD, MBA, chair of the Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska, said that the findings are “concerning and important because we know that public health information is spread on social media and we know that youth eyeballs are really going to be on social media platforms like Instagram, TikTok, and YouTube.”

“There’s a lot of misinformation on these platforms, so I think it’s really important for us as healthcare organizations to be on those platforms to make sure that we are spreading accurate information. The APA is pretty proactive and has put a lot of accurate content out there in terms of addiction and health,” Liu said. 

Also providing perspective, Rob Morris, PhD, CEO of Koko, a nonprofit that uses artificial intelligence to detect dangerous mental health content, said that content moderation is a “very difficult problem, even for the largest companies on the internet. Issues related to vaping are no exception. Hashtags and slang terms are constantly evolving, and they can evade even the most robust detection systems.”

“Ultimately, companies cannot handle this issue alone and it is important that they consider working with non-governmental organizations and other organizations to identify gaps in their systems,” Morris said. 

The study had no specific funding. Tran, Liu, and Morris have no relevant disclosures.