Julia Chen-Sankey

Background and aims: Use of derived intoxicating cannabinoid products (DICPs) has grown in the United States (US), as have associated poisonings, emergency department visits and psychotic episodes. Brand marketing on social media, a largely underregulated marketing channel, may be contributing to this growth. To inform prevention efforts, this study characterized marketing features used by leading DICP brands on Instagram. Design: Qualitative content analysis. Setting and cases: A total of 837 Instagram posts published by nine leading DICP brands' (CannaAid, Cycling Frog, Delta Extrax, Elyxr, Fly Urb, Hometown Hero, Koi CBD, Mood and Official Canna River) accounts between February 2024 and February 2025. Measurements: The research team developed a codebook of marketing features using both inductive and deductive methods, and two trained coders analyzed the content of the posts ( n = 837). Frequencies were calculated for each marketing feature, and Chi‐squared tests were used to examine associations of marketing feature themes by brand and product type. Findings: Social media posts featured product descriptors and imagery (product theme; 75.3%), recreational effects and enjoyment appeals (recreational theme; 52.0%), youth‐oriented imagery and cultural cues (youth theme; 49.6%), brand and value positioning (brand theme; 35.7%), health and therapeutic benefit claims (health theme; 10.2%) and health and age warnings (warning theme; 2.5%). Theme presence differed statistically significantly by brand ( P s< 0.001). Cycling Frog used product (93.4%), recreational (83.7%) and brand (50.6%) themes most frequently. Mood (64.4%) and Delta Extrax (60.1%) used the youth theme most frequently, while Hometown Hero (23.7%) and Koi CBD (17.7%) used the health theme most frequently. Themes also varied statistically significantly by product type ( P s< 0.05). Beverages were the product type most commonly marketed with product (97.4%), recreational (84.3%), youth (56.9%) and brand (40.5%) themes. Edibles (60.8%) and pre‐rolls/blunts (52.9%) were frequently marketed with the recreational theme, while cartridges/vapes (53.5%) and edibles (49.2%) were frequently marketed with the youth theme. Conclusions: Between February 2024 and February 2025, Instagram posts from leading brands of derived intoxicating cannabinoid products frequently emphasized product, recreational and youth‐oriented themes, while age restrictions and health warning messages were less common. Marketing content varied by brand and product type, with beverages particularly likely to feature recreational, lifestyle and youth‐appealing elements.

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: Advertising for cannabis vape products (CVPs) often highlights product features related to their functions and perceived benefits. Such messages may encourage CVP use among young adults (YAs), a group with rising prevalence and heightened vulnerability to CVP use. We examined the associations between noticing product feature messages in CVP ads and product use perceptions among US YAs of varying CVP-use statuses. Methods: YAs (n = 2024) who either use CVPs or are susceptible to CVP use completed an online heatmap (a visualization tool representing attention data) experiment in 2024. Participants viewed 6 CVP ads that each portrayed 3 of the following 9 types of product feature messages: creativity, physical health benefits, social enhancement, mental health benefits, relaxation, positive flavor sensation, positive mood effects, convenience/discreetness, and elevated potency. Participants clicked on the message that most attracted their attention in each ad and then reported use intentions, positive use expectancy, and perceived mental and physical health benefits related to using the advertised products. We examined associations between noticing product feature messages and perception outcomes, controlling for covariates. Results: Noticing messages about physical health benefits was positively associated with product use intentions (coef. = 0.343, P = .000), positive use expectancy (coef. = 0.107, P = .002), and perceived physical (coef. = 0.189, P = .000) and mental (coef. = 0.171, P = .000) health benefits. Noticing messages about social effects was positively associated with product use intentions (coef. = 0.410, P = .000), positive use expectancy (coef. = 0.163, P = .000), and perceived mental health benefits (coef. = 0.229, P = .000). Additionally, noticing messages about creativity was positively associated with product use intentions (coef. = 0.164, P = .007). Conclusions: Attention to several product feature messages in CVP ads was associated with intentions and positive perceptions of using the advertised CVPs among YAs, which may lead to future use. Results from this study can inform strategies for reducing the appeal and influence of CVP marketing among this vulnerable population.

Introduction: Little is known about intentions to use Food and Drug Administration-authorized e-cigarettes (FAEs) among U.S. adults who smoke cigarettes despite initial product authorizations and ongoing reviews. This study examined such intentions in this population. Methods: We conducted an online survey in 2024 with adults who smoke cigarettes (n = 2612; ages 21-70) in the U.S. using a national panel. Participants read a description of FAEs and then answered related questions. We assessed the weighted prevalence of intentions to use FAEs (in general and for quitting) and used bivariate and multivariable ordinal logistic regressions to examine associations between sociodemographic, tobacco use behaviors, and FAE use intentions. Results: Over half of the participants reported being “somewhat,” “very,” or “extremely” interested in using FAEs in general (53%) and to quit smoking (53%). The multivariable regressions showed participants who reported their subjective financial situation as “do not meet basic needs” or had a high school degree or less had lower FAE use intentions than those who reported they “live comfortably” or had higher education, respectively. Those with plans to quit smoking or who had used e-cigarettes and FAEs before reported increased FAE use intentions than those who had no plans to quit and had never used those products before, respectively. Conclusion: FAEs may appeal to more than half of adults who smoke cigarettes, though people with lower socioeconomic statuses or no plans to quit reported lower FAE use intentions. This study can inform policy and communication strategies related to e-cigarette authorization in the U.S. Implications: This study is among the first nationally representative surveys among U.S. adults who smoke cigarettes to examine the prevalence of intentions to use Food and Drug Administration-authorized e-cigarettes (FAEs), both in general and for smoking cessation, and the socioeconomic and tobacco use–related factors associated with these intentions. The study found that FAEs may appeal to more than half of adults who smoke, though people with lower socioeconomic statuses or no plans to quit smoking reported reduced FAE use intentions. This study can inform policy and communication strategies related to e-cigarette authorization in the U.S.

Background: Cannabis vaping prevalence and marketing has increased, but limited research has assessed effects of specific advertising messages, warnings, or their combinations on young adults’ perceptions. This study aimed to advance this research. Methods: In 2024, 3581 US young adults aged 18 to 34 (40.8% reporting past-month use) participated in an online survey-based experiment using a 2 × 4 factorial design (advertising message: psychological effects vs flavors; warning: none, adult-use, intoxication, vape-specific) and then reported on 5 perception outcomes: addictiveness, harm, cautiousness, appeal, and interest (0 = not at all to 7 = extremely). Multivariable regression assessed advertising message, warning, and message-by-warning interactions in relation to outcomes, overall and by past-month use status. Results: Among the total sample and among participants reporting no cannabis use, there were no main or interaction effects of advertising message or warning conditions. Among participants reporting use, adult-use (vs no) warning exposure was associated with lower addictiveness and cautiousness; intoxication (vs no) warning exposure was associated with lower harm. A significant interaction indicated that participants reporting use who were exposed to both psychological effects (vs flavors) advertising messages and intoxication (vs no) warnings reported greater appeal, whereas those exposed to both flavors (vs effects) advertising messages and intoxication (vs no) warnings reported lower appeal. Conclusions: These findings highlight the importance of understanding how advertising messages may affect how warnings are interpreted (or vice versa), strengthening the evidence base informing advertising restrictions and warning requirements, and elucidating the mechanisms driving the differences among young adults who use versus do not use cannabis.

Introduction: We tested whether e-cigarette advertisements (ads) with a claim of reduced chemical exposure (RCE) and various brands impact e-cigarette-related perceptions among young people. Methods: A randomized, 2 × 3 between-subjects experiment was embedded in a web-based survey of youth (ages 13-17) and young adults (ages 18-29) who smoke cigarettes (n = 1667) or who do not use tobacco (n = 833). Participants viewed 1 of 6 e-cigarette ad conditions that varied according to 2 manipulated factors: RCE claim (present or absent) and e-cigarette brand (Logic Power, Vuse Vibe, or Njoy Ace). After viewing the ad, perceptions about the ad and the promoted e-cigarette product in the ad were assessed. Results: We did not observe an e-cigarette brand effect or interactive effects between the two main factors on any outcomes. Among those who smoke, the RCE claim generated increased perceptions that the ad made them want to use (P = .039) or completely switch to the e-cigarette (P = .048). Among those who do not use tobacco, it led to elevated perceptions that the e-cigarette is less addictive than cigarettes (P = .034) and intentions of using the e-cigarette compared to cigarettes (P = .009). Conclusion: E-cigarette ads containing a RCE claim may be perceived as more effective in influencing product use and complete switching intentions among young people who smoke. While we did not observe such an effect among those who do not use tobacco, future efforts to promote e-cigarette MRTP claims should aim to limit exposure to such claims among this audience to mitigate the potential for unintended effects. Implications: This study demonstrates the potential influence of reduced chemical exposure (RCE) claims in advertisements (ads) for US Food and Drug Administration-authorized e-cigarette products among young adults who smoke, suggesting that such claims may enhance the perceived effectiveness of advertising. Although we found few significant effects among tobacco-naïve youth and young adults, any efforts to promote e-cigarette RCE claims should aim to limit exposure to such claims among these young audiences to mitigate the potential for unintended effects. These results will be critical to understanding how RCE claims in e-cigarette ads may differentially shape e-cigarette-related perceptions and behaviors across young people of diverse tobacco-use groups.

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.