Social media is helping spur the e-cigarette epidemic among America's teens, a new study suggests.
Nearly 15 000 Instagram posts related to Juul, the most popular e-cigarette brand, were released between March and May 2018, researchers found.
Links to commercial websites
More than half the posts focused on youth culture or lifestyle-related content that would appeal to teens, according to results published in the journal Tobacco Control.
One-third of the posts contained overt promotional content that highlighted ways to obtain Juul-related products at a reduced cost, including discounts and giveaways, the researchers added.
These promotional posts "had links to commercial websites", said senior researcher Elizabeth Hair, senior vice president of the Schroeder Institute, Truth Initiative, in Washington, D.C. "Not all of them were from Juul corporate; some of them were from companies selling the Juul product."
This sort of social media promotion is fuelling the use of e-cigarettes among teens, Hair said.
"Over 20% of our youth are using e-cigarettes," Hair said. "We've been doing such a great job of changing the nation's direction on cigarette usage, and now we have a new epidemic we're facing."
But Juul Labs spokesperson Lindsay Andrews noted that during those three months, the company itself issued only eight Instagram posts.
Most posts from third-party users
"Six of these were testimonials from former adult smokers, one was a letter from our CEO concerning youth prevention, and the last was a photo of a Juul engineer," Andrews said. "During the time period of this study, third-party users generated well over 99.9% of the Instagram content related to Juul products."
In November, Juul Labs overhauled its social media policies to further restrict its social media presence, Andrews added. The company deleted its Facebook and Instagram accounts, and has limited its Twitter account to non-promotional communications like corporate announcements or press releases.
"We don't want youth using our product," Andrews said. "Our product was designed to help adult smokers who want a true alternative to combustible cigarettes."
Juul is a high-tech vaping device that looks much like a computer flash drive. Its detachable pods come in various flavours, including mint, fruit, mango and cucumber.
Juul currently holds nearly three-quarters of the US e-cigarette market share, and its popularity was aided by innovative marketing strategies across social media platforms, researchers claimed in background notes.
To get an idea of the way Juul is discussed on social media, Hair and her colleagues used 50 hashtag-based keyword queries to collect Juul-related posts from Instagram.
More than half of posts targeted youth
The researchers found that 55% of the posts contained youth-related content, including memes, cartoon imagery, flavours or celebrity references. These posts also featured stealth vaping in class or at home, and use of Juul at school and other places frequented by teens.
At the same time, 57% of the posts mentioned lifestyle-related content, highlighting shared use of Juul between family and friends during fun times and activities.
About one in 10 posts mentioned references to nicotine in Juul or its addictive potential, most often in a fun light.
For example, one post contained a cartoon image of Buzz Lightyear with a Juul in his fist, and a tagline reading, "When you're buzzzin hard." Another compared the addictive nature of Juul to binge-watching Netflix shows and reading just one more page of a book.
Christine Fardellone is a certified tobacco treatment specialist at Northwell Health's Center for Tobacco Control in Great Neck, New York. "Electronic cigarettes are marketed using similar techniques proven to lead youth to smoking, including candy-flavoured products, celebrity endorsements and powerful themes of glamour, freedom and fun," she said.
"Frequent exposure to tobacco products through social media is likely to appeal to youth and young adults," Fardellone continued. "Limiting exposure to digital marketing through social media may prevent teenagers from getting hooked on tobacco products and prevent a lifetime of nicotine addiction and tobacco-related illness."
E-cigs still promoted among youth
The results of this three-month Instagram search were "disturbing", said Dr Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City.
"Every young person has Instagram, and that's how they share information," Horovitz said. "The actual industry doesn't have to do anything but let the people using the device share their insights, and advice and encouragement."
Horovitz dismissed Juul's contention that nearly all of the Instagram posts were created by others, noting that the promotional posts often linked back to either Juul's website or the website of a retailer selling Juul.
"The manufacturers can say, we're not really promoting this as much as young people are, they're driving it, we're not.' And it's just not true," Horovitz said. "They're putting the information out there in a positive way and then they're allowing the users to exponentially spread the information."
Regulators need to step in
Andrews said that Juul agrees "these types of social media posts are a serious problem and that is why we employ a social media monitoring team dedicated to submitting takedown requests to social media platforms like Instagram of exactly the type of inappropriate third-party social media content the authors cite as problematic."
To date, the Juul Labs social media team has succeeded in having removed 31 889 social media listings, including 25 405 individual Instagram posts, Andrews said.
Still, Hair said, regulators need to step in and limit what can and cannot be promoted on social media when it comes to e-cigarettes.
"If we can stop the promotional pieces of it, I think that will help stem a lot of it," Hair said. "A lot of this content was from companies that were selling the product and had these promotional aspects to it."
Andrews noted that "there are more than 34 million current adult smokers in the US and more than a billion worldwide. Our product was designed to help these adult smokers who want a true alternative to combustible cigarettes. Youth usage endangers our opportunity to sell to these adult smokers."
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