Jon-Patrick Allem

A programming script was used to collect the subject line, date, time and content of each e-mail using the Gmail Application Programming Interface (API).5 E-mails sent by tobacco brands were collected between 1 November 2024 and 1 November 2025.1 To capture a range of tobacco product marketing practices, six tobacco brands (ie, brands with international recognition, history and market share)6 7 were selected across product classes: cigarettes (Lucky Strike, Winston), e-cigarettes (Lost Mary, Vuse) and nicotine pouches (Zyn, Velo). Next, a member of the research team created accounts on each brand website using a research Gmail account. If required by the website, personal identifying information was provided. When required, age verification procedures were completed as part of …

Objective: To summarise how anti-tobacco mass media campaigns delivered via digital media are evaluated, including campaign characteristics, targeted populations, behavioural outcomes and exposure measurement strategies. Data sources: Six databases (PubMed, Web of Science, Scopus, PsycINFO, Embase, Communication & Mass Media) were searched using tobacco-related, digital media-related and prevention-related terms. Study selection: Articles were eligible if they were peer-reviewed, written in English, published between 2004 and 2025 and evaluated an anti-tobacco mass media campaign that used social media or web-based platforms and assessed a tobacco-related behaviour. Studies that exclusively assessed campaign awareness, knowledge or attitudes towards tobacco use were excluded. Data extraction: Two independent coders screened all titles and abstracts. Full texts were coded for campaign characteristics, exposure measurement and behavioural outcomes. Data synthesis: The final sample included 21 studies with 236 915 participants. Most campaigns were conducted in the USA (n=16, 76.2%) and used national samples (n=17, 81.0%). Campaigns targeted adolescents (n=87 746, 45.2%) and young adults (n=83 683, 38.7%). Exposure was assessed using aided recall (n=12, 57.1%) and binary response formats (n=9, 42.9%). Across all studies, 37 statistical effects were reported; the most examined behavioural outcomes were past 30-day tobacco use (k=15, 40.5%) and quit intentions (k=12, 32.4%). Of these, 73.3% (k=11/15) and 75.0% (k=9/12) reported statistically significant improvements, respectively. Conclusions: Digital anti-tobacco mass media campaigns show promise in influencing tobacco-related behaviours. However, existing exposure measures in the evolving digital environment may limit the ability to accurately link campaign exposure to behavioural outcomes. Advances in exposure measures are needed.

Background: Instagram hosts pro-tobacco content that may reach youth despite existing US federal and platform-specific policies designed to restrict such content. This study assessed compliance with platform-specific and federal tobacco control policies among leading tobacco brands on Instagram. Methods: This study collected 1654 Instagram posts between October 1, 2022, and September 29, 2024, from the main page and tagged sections of six leading tobacco brand accounts (Vuse, Lost Mary, ZYN, Velo, Lucky Strike, Winston). Posts were coded for compliance with Instagram, Federal Trade Commission (FTC) and US Food and Drug Administration (FDA) policies, including age-gating, financial disclosure, presence of health warnings and restricted URLs. Results: 69.4% (n=1148) of posts contained URL links to commercial tobacco websites. Unrestricted access to tobacco content was observed among 46.7% (n=772) of posts. Influencers or celebrities appeared in 19.2% (n=317) of posts, of which 41.6% (n=132) of posts did not disclose a financial relationship between the brand and the influencer or celebrity. 72.6% (n=1200) of posts had a health warning label, while 41.3% (n=683) of posts had an age warning label . Conclusions: Leading tobacco brands on Instagram often violated platform and federal policies, particularly those concerning age verification, sponsorship disclosure and health warning labelling. Stronger enforcement by Instagram, the FTC and the FDA may be needed to reduce youth exposure to tobacco marketing on social media.

Introduction: Brands can be “tagged” in Instagram posts to communicate a partnership with a social media influencer. Little is known about the content of these communications in the tobacco-related literature. To address this gap, this study identified tagged posts on the official Instagram pages of tobacco brands and described the themes of such posts. Methods: Six tobacco brands with official Instagram pages were identified. Each tagged section of the brand’s official Instagram page was examined to identify potential partnerships with social media influencers. Posts to the tagged section of the Instagram page were collected from November 2022 to February 2024. For each post, tobacco-related themes were coded. Results: This study identified 594 tagged posts from 222 potential social media influencers. The most common theme among tagged posts was product presence (n = 430, 72.4%), followed by branding (n = 421, 70.9%). Young adults were identified in 40.4% (n = 240) of posts. Among users who tagged a brand account, 96.1% (n = 571) of their account profiles contained URL links to commercial Web sites, suggesting social media influencer status. Conclusions: This study showed that the tagged section of tobacco brands’ Instagram pages contained posts suggestive of paid partnerships between the brand and social media influencers. These posts often featured tobacco use and young adults. Future research should examine whether the presence of (or accessibility to) URL links to commercial Web sites appearing on influencers’ pages increases an Instagram user’s purchase intentions and tobacco use initiation. Implications: This study showed that the “tagged” sections of the official Instagram pages of six tobacco brands featured tobacco use, contained links to commercial Web sites, avoided content about addiction, and revealed that social media influencers inconsistently disclosed financial relationships with tobacco brands. In addition to enforcing and bolstering online marketing restrictions, prevention programs and interventions may focus on tobacco-related digital media literacy to help inoculate young adults against the protobacco online environment.

Background: Pairing e-cigarettes with healthy lifestyle contexts in influencers promotional social media posts may increase e-cigarette use risk among young adults. This study examined the effects of e-cigarette and healthy lifestyle content on young adults perceptions of influencer credibility, harm perceptions of, and susceptibility to use, e-cigarettes. Methods: In this survey-based online, repeated-measures experiment (2023), California young adults (N=1494, M _age =23 (SD=1.8); 63% female, 51% Hispanic) were randomly shown 10 (total) Instagram and TikTok videos, featuring influencers promoting e-cigarettes alongside healthy lifestyle activities (experimental group), or a healthy lifestyle activity alone (control). After watching each video, participants rated perceived influencer credibility (eg, honesty). After watching all videos, harm perceptions of e-cigarettes were assessed among all participants and susceptibility to e-cigarette use was assessed among e-cigarette never-users. Harm perceptions and susceptibility outcomes were compared between groups (experimental vs control) and between participants who perceived influencers as credible versus non-credible, using binomial generalised linear mixed effects models. Results: Participants in the experimental group were more likely to report lower harm perceptions (adjusted OR (AOR) 1.12; 95% CI 1.03; 1.21) and higher susceptibility to e-cigarette use (AOR 1.22, 95% CI 1.11; 1.34), than participants in the control condition. Similar results were found when influencers were perceived as credible, but not when they were perceived as non-credible. Conclusions: Social media influencers posts promoting e-cigarette use along with healthy activities may contribute to young adult e-cigarette use. Decreasing perceived credibility of influencers could decrease the negative effects of their promotional posts. Trial registration number: NCT06433466 .

Introduction: Nicotine pouches are the fastest-growing oral smokeless tobacco or nicotine product category in the United States, and there are concerns about their potential appeal to youth. Few studies have surveilled discussions about nicotine pouches on TikTok, an audiovisual platform popular among youth. To address this gap, this study conducted a content analysis of TikTok posts related to the leading nicotine pouch brand, ZYN. Aims and Methods: Publicly available posts (N = 665) from 10 ZYN-related hashtags were collected from the TikTok Application Programming Interface (API) between January 2023 and February 2024. The number of likes, comments, shares, and plays was collected for each post and the number of followers for each account profile was recorded. Posts were coded for themes such as product marketing and use, health warnings, and demographics. Results: The most prevalent theme was humor (n = 581, 87.4%), followed by product use (n = 378, 56.8%), and branded merchandise (n = 378, 56.8%). Young people (ie persons in the video who appeared younger than 30) were identified in 48.3% (n = 321) of posts, and 61.5% (n = 409) of posts featured people who appeared to be male. Cessation (n = 12, 1.8%) was an uncommon theme. Most posts came from noncommercial accounts (n = 420, 63.1%), followed by commercial accounts (n = 158, 23.8%), and content creators/influencers (n = 87, 13.1%). Conclusions: This study showed that ZYN-related posts on TikTok often featured pro-tobacco themes, such as humor and product use, while rarely mentioning anti-tobacco themes such as cessation. Future research should examine the relationship between exposure to pro-tobacco content on TikTok and tobacco-related attitudes and behaviors. Implications: This study highlighted the potential role of TikTok in normalizing tobacco and nicotine product use, and in particular ZYN product use, including among youth. While increased enforcement of online tobacco control policies can help reduce exposure to ZYN-related content in youth, prevention programs and interventions that incorporate tobacco-related digital media literacy are needed to inoculate adolescents and young adults from the pro-tobacco content found online.