JMIR Publications

ABSTRACT

Background:

Inhaling aerosolized nicotine and cannabis (colloquially called “vaping”) is prevalent among young adults. Instagram influencers often promote both nicotine and cannabis vaporizer products. However, Instagram posts discouraging use of both products received national media attention during the 2019 outbreak of E-Cigarette or Vaping-Associated Lung Injury (EVALI).

Objective:

This experiment tested the impact of viewing Instagram posts about EVALI, varying in image and text valence, on young adults’ perceived harmfulness of nicotine and cannabis products, perceived risk of e-cigarette use, and susceptibility to using nicotine and cannabis vaporizers in future.

Methods:

Participants (N=1,229) ages 18-25 (M=21.40, SD=2.22) were recruited through Qualtrics Research Services, oversampling for ever-use of nicotine or cannabis vaporizers (50.3%). Participants were randomly assigned to view Instagram posts from young people portraying their experiences of EVALI in a 2 (image valence: positive or negative) X 2 (text valence: positive or negative) between-subjects experiment. Positive images were attractive, aesthetically pleasing selfies. Positive text was supportive and uplifting in regard to quitting use of vaporized products. Negative images and text were graphic and fear-inducing. After viewing three posts, participants reported perceived harmfulness of nicotine and cannabis products, perceived risk of nicotine and cannabis vaporizer use, and susceptibility to using nicotine and cannabis vaporizers in the future. Ordinal logistic regression models assessed the main effects and interactions of image and text valence on perceived harmfulness and risk. Binary logistic regression models assessed the main effects and interactions of image and text valence on susceptibility to nicotine and cannabis vaporizer use. Analyses adjusted for product use history.

Results:

Compared to viewing positive images, viewing negative images resulted in greater perceived harm of nicotine and cannabis vaporized products, greater perceived risk of nicotine vaporizers (ps<.05), and lower odds of susceptibility to using nicotine (p<.05), but not cannabis (p>.05) vaporizers in the future. There were no significant main effects of text valence and no significant image and text valence interactions (p-values>.05).

Conclusions:

Instagram posts about EVALI that employ negative imagery may convey the risks of vaporized product use and discourage young adults from this behavior, regardless of the valence of the post’s text. Public health messaging regarding EVALI on Instagram should emphasize the risk of cannabis vaporizer use, as young adults may otherwise believe that only nicotine vaporizer use increases their risk for EVALI.