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<p>Despite declines in adolescent cigarette smoking, youth tobacco use remains a public health concern as non-cigarette products such as electronic nicotine delivery systems (ENDS) have become more popular. Social media is a key venue where adolescents may encounter tobacco-related content that could shape perceptions of product harm, yet few studies have tested whether social media use frequency is associated with changes in comparative harm perceptions across tobacco products over time. We analyzed Waves 2–5 of the Population Assessment of Tobacco and Health (PATH) Study, including 7,759 adolescents who had never used tobacco at baseline (Wave 2). Social media use frequency was categorized as none, non-daily, or daily. Outcomes were comparative harm perceptions, defined as perceiving ENDS, hookah, cigars, or smokeless tobacco as “less harmful” versus “same or more harmful,” relative to cigarettes. We estimated within-person associations using fixed-effects logistic regression and population-averaged associations using generalized estimating equation (GEE) logistic models adjusted for socio-demographic characteristics. More frequent social media use was associated with lower comparative harm perceptions for ENDS in both fixed-effects and GEE models. For hookah, non-daily and daily social media use were associated with lower perceived harm in fixed-effects models, whereas only daily use was significant in GEE models. Smokeless tobacco showed an association only among daily users in fixed-effects models, and no associations were observed for cigars. In summary, among adolescents who were never used tobacco at baseline, higher social media use frequency was associated with lower comparative harm perceptions, particularly for ENDS and hookah. These findings underscore the importance of youth-focused tobacco prevention and public health messaging that addresses misperceptions of tobacco-related harm in online environments and may inform efforts to reduce youth exposure to tobacco-related marketing and harm information on digital platforms.</p>

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Shaping Perceptions Online: The Frequency of Social Media Use and Comparative Harm Perceptions of Tobacco Products among U.S. Adolescents

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月16日

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  • Xiao Li,
  • Michael G. Vaughn,
  • Hong Xian,
  • Zhengmin Qian

摘要

Despite declines in adolescent cigarette smoking, youth tobacco use remains a public health concern as non-cigarette products such as electronic nicotine delivery systems (ENDS) have become more popular. Social media is a key venue where adolescents may encounter tobacco-related content that could shape perceptions of product harm, yet few studies have tested whether social media use frequency is associated with changes in comparative harm perceptions across tobacco products over time. We analyzed Waves 2–5 of the Population Assessment of Tobacco and Health (PATH) Study, including 7,759 adolescents who had never used tobacco at baseline (Wave 2). Social media use frequency was categorized as none, non-daily, or daily. Outcomes were comparative harm perceptions, defined as perceiving ENDS, hookah, cigars, or smokeless tobacco as “less harmful” versus “same or more harmful,” relative to cigarettes. We estimated within-person associations using fixed-effects logistic regression and population-averaged associations using generalized estimating equation (GEE) logistic models adjusted for socio-demographic characteristics. More frequent social media use was associated with lower comparative harm perceptions for ENDS in both fixed-effects and GEE models. For hookah, non-daily and daily social media use were associated with lower perceived harm in fixed-effects models, whereas only daily use was significant in GEE models. Smokeless tobacco showed an association only among daily users in fixed-effects models, and no associations were observed for cigars. In summary, among adolescents who were never used tobacco at baseline, higher social media use frequency was associated with lower comparative harm perceptions, particularly for ENDS and hookah. These findings underscore the importance of youth-focused tobacco prevention and public health messaging that addresses misperceptions of tobacco-related harm in online environments and may inform efforts to reduce youth exposure to tobacco-related marketing and harm information on digital platforms.