Effects of a Social Media Intervention on Vaping Intentions: Randomized Dose-Response Experiment

"This study provides evidence to support the idea that targeted campaign messages can directly impact attitudes, beliefs, and behavioral intentions focused on the content of those messages."

The importance of digital media interventions is growing in many health behaviour subject areas, including nicotine and tobacco use research. The purpose of this study was to determine whether a social media intervention delivered through an experimental design would have a positive effect on young adult vaping (e-cigarette) outcomes. It also sought to determine dose-response effects of varying levels of exposure to the intervention on vaping outcomes, including anti-industry beliefs, vaping intentions, and other attitudes and beliefs related to vaping.

The intervention content consisted of four 15-second videos drawn from a previous web-based Truth Initiative campaign called Tested on Humans. The main themes of the videos were that vaping companies do not know the health and other impacts of using e-cigarettes and that they are "testing" their products on human beings. This strategy is consistent with an "anti-industry" countermarking approach to nicotine and tobacco campaigns. The campaign was not publicly active during this study.

Participants were adults aged 18 to 24 years in the United States. They were recruited into the study through Facebook (Meta Platforms) and Instagram (Meta Platforms), completed a baseline survey, and then were randomised to 1 of the 5 conditions: 0 (control), 4, 8, 16, and 32 exposures over a 15-day period between each survey wave. Following baseline, videos were promoted in the live Facebook and Instagram feeds of treatment arm participants in a random order and combinations to achieve the targeted impressions for each arm (i.e., an average number of impressions per condition). Follow-up data were collected 30 and 60 days after randomisation. The main outcome measures reported in this study were self-reported exposure to social media intervention content, attitudes and beliefs about vaping, and vaping intentions.

The baseline sample consisted of 1,491 participants, and the final analysis sample consisted of 57.28% (854/1491) of the participants retained at the 60-day follow-up. There were no statistically significant differences across demographic variables among the retained participants as compared to those lost to follow-up.

The researchers found a significant effect of the social media treatment on vaping intentions (β=-0.138, 95% confidence interval (CI) -0.266 to -0.010; P=.04) and anti-industry beliefs (β=-0.122, 95% CI 0.008-0.237; P=.04) targeted by the intervention content among current vapers but not among the full sample or other strata. In terms of why the study did not find effects among former and never-vapers, the researchers suggest that "it is simply difficult to shift beliefs and intentions in those other groups than among current vapers. Alternatively, messages focused on topics and persuasive content other than anti-industry sentiment may be needed for those groups."

Higher levels of treatment (i.e., from arms 1 to 5) were associated with the anti-industry beliefs and vaping intentions outcomes of interest. However, there was no direct or dose-response effect of the intervention on content exposure outcomes (i.e., awareness of the specific social media posts used as stimulus in the study). Per the researchers, it is possible that the lack of relationship between the treatment group and reported advertisement exposure is because of insufficient elapsed time during the intervention period to achieve the intended number of impressions per group, which resulted in participants in the fourth and fifth groups receiving similar levels of impressions. "To fully examine the dose-response effects of social media interventions, longer time durations may be needed, and larger small sample sizes per study arm may be needed..."

In conclusion: "The observed effects on lower vape use intentions suggest that there may be a connection between anti-industry beliefs and future use among current users. If young adults believe that the industry is using misinformation and disinformation and selling a harmful product, they may reconsider their current use....This suggests a potential mediation effect of anti-industry beliefs on intentions and potentially on e-cigarette use. The hypothetical pathways of effects should be formally evaluated in future studies."