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Meta-Analysis
. 2022 Sep 1;176(9):878-885.
doi: 10.1001/jamapediatrics.2022.2223.

Association Between Exposure to Tobacco Content on Social Media and Tobacco Use: A Systematic Review and Meta-analysis

Scott I Donaldson  1 , Allison Dormanesh  1 , Cindy Perez  1 , Anuja Majmundar  2 , Jon-Patrick Allem  1
Affiliations
Meta-Analysis

Association Between Exposure to Tobacco Content on Social Media and Tobacco Use: A Systematic Review and Meta-analysis

Scott I Donaldson et al. JAMA Pediatr. .

Abstract

Importance: Exposure to tobacco-related content on social media may foster positive attitudes toward tobacco products and brands, and influence the likelihood of initiating or continuing use of tobacco, especially among adolescents and young adults.

Objective: To perform the first systematic review and meta-analysis, to our knowledge, on studies that examined the association between exposure to tobacco content on social media and lifetime tobacco use, past 30-day tobacco use, and susceptibility to use tobacco among never users.

Data sources: Tobacco, social media, and marketing search terms were entered into online databases, including MEDLINE, ISI Web of Science, Scopus, and PsychINFO. Study characteristics, including research design and methods, sampling strategy, and demographics, were assessed for each study.

Study selection: Studies reporting odds ratios (ORs) for self-reported exposure to, or experimentally manipulated, tobacco content on social media and lifetime tobacco use, past 30-day tobacco, and susceptibility to use tobacco among never users. The systematic search produced 897 independent articles, of which 29 studies met inclusion criteria.

Data extraction and synthesis: A 3-level random-effects meta-analysis was used to estimate ORs, 95% CIs, and heterogeneity (I2) for each tobacco use outcome. Study quality and publication bias were assessed.

Main outcomes and measures: Lifetime tobacco use, past 30-day tobacco use, and susceptibility to use tobacco among never users. Tobacco use included e-cigarettes, cigarettes, and other (cigar, hookah, smokeless tobacco).

Results: The total sample size across the 24 included datasets was 139 624, including 100 666 adolescents (72%), 20 710 young adults (15%), and 18 248 adults (13%). Participants who were exposed to tobacco content on social media, compared with those who were not exposed, had greater odds of reporting lifetime tobacco use (OR, 2.18; 95% CI, 1.54-3.08; I2 = 94%), past 30-day tobacco use (OR, 2.19; 95% CI, 1.79-2.67; I2 = 84%), and susceptibility to use tobacco among never users (OR, 2.08; 95% CI, 1.65-2.63; I2 = 73%). Subgroup analyses showed similar associations for tobacco promotions, active engagement, passive engagement, lifetime exposure to tobacco content, exposure to tobacco content on more than 2 platforms, and exposure to tobacco content among adolescents and young adults.

Conclusions and relevance: Findings suggest that a comprehensive strategy to reduce the amount of tobacco content on social media should be developed by federal regulators. Such actions may have downstream effects on adolescent and young adult exposure to protobacco content, and ultimately tobacco use behaviors.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Allem reported grants from the Tobacco-Related Disease Research Program during the conduct of the study and grants from the California Department of Public Health California Tobacco Control Program and the National Cancer Institute outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. PRISMA Diagram of Study Inclusion
Figure 2.
Figure 2.. Forest Plot of 3-Level Meta-analysis for Exposure to Tobacco Content on Social Media and Lifetime Tobacco Use, Including e-Cigarettes, Cigarettes, and Other Tobacco Use
Figure 3.
Figure 3.. Forest Plot of 3-Level Meta-analysis for Exposure to Tobacco Content on Social Media and Susceptibility to Use Tobacco Among Never Users
See this image and copyright information in PMC

Comment in

  • Protecting Children in Social Media.
    Jernigan DH. Jernigan DH. JAMA Pediatr. 2022 Sep 1;176(9):848-849. doi: 10.1001/jamapediatrics.2022.2232. JAMA Pediatr. 2022. PMID: 35816324 No abstract available.

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