JMIR Publications

ABSTRACT

Background:

Adolescents’ exposure to e-cigarette content through social media platforms (SMPs) influences their perceptions and behaviors, though cross-country analyses are scarce.

Objective:

This study evaluated the association between e-cigarette exposure on SMPs and e-cigarette susceptibility and use in Jalisco, Mexico and Southern California (SoCal), U.S.

Methods:

In 2022-23, students from 23 high schools in Jalisco (n=1,417) and 11 in SoCal (n=3,573) were surveyed with harmonized measures on past-month frequency of SMPs use (i.e., YouTube, Instagram, TikTok, Snapchat, WhatsApp, Facebook, Twitter, and Twitch) and seeing e-cigarette posts on each SMP used; which were recoded to 5-point scores (range 0-4) for SMP use and e-cigarette posts exposure. Country-stratified logistic models regressed e-cigarette susceptibility (among non-current users) and past-month use on SMP scores, adjusting for age, sex, family affluence, and friends’ e-cigarette use.

Results:

Past-month e-cigarette use was higher in Jalisco (17.5%) than SoCal (5.3%, p<.001). SMP use and e-cigarette exposure on each SMP differed across samples (p-values <.001). In SoCal, more frequent SMP use was positively associated with e-cigarette susceptibility (AOR=1.83, 95%CI[1.48-2.25]), whereas in Jalisco, higher frequency of exposure to e-cigarette content was associated with susceptibility (AOR=1.21, 95%CI[1.02-1.43]). Higher frequency of SMP use and exposure to e-cigarette content were both positively associated with past-month e-cigarette use in SoCal; in Jalisco, greater SMP exposure to e-cigarette content was associated with past-month use.

Conclusions:

Frequent SMP use and e-cigarette exposure through SMPs appear to be associated with e-cigarette susceptibility and use across contexts. Stronger policies to limit and enforce online exposures are needed.