Perhaps one of the greatest achievements of public health policy in recent years has been the significant decline in smoking among the population of the United Kingdom. However, this decline has begun to stall. In this context, it is important to examine how young people are introduced to smoking and e-cigarettes and what are the factors that influence them.
A timely study by Hopkinson and colleagues (2024) hopes to shed some light on this. Their aim was to investigate the link between time spent on social media and use of e-cigarettes or tobacco cigarettes among young people.
What drives young people’s decisions around smoking tobacco or e-cigarettes?
Methods
The authors used data from a large annual UK household survey. The focus was on participants aged between 10 and 25 years of age. This covered the period from 2015/16 through to 2020/21. It was in 2015/16 that a question about use of e-cigarettes was added to this annual survey, so was the earliest point that data was available.
28,000 households were included in the sample. Data was collected through a mix of face-to-face interviews and online questionnaires.
Young people were classed as smokers if they usually smoked 1-6 cigarettes a week. To be classed as an e-cigarette smoker, individuals had to report using these products at least once a week.
Participants were asked if they belonged to any social networking websites, although the authors did not have access to the specific social media sites young people engaged with. Popular social media sites included X (formerly Twitter), Facebook and WhatsApp for example. They were then asked to estimate the time spent on these websites on a typical day, ranging from none through to more than 7 hours, with various options in between the two. Engaging for at least one hour a day would class the individual as a social media user.
Essentially most of the statistical analysis was based on placing participants into binary groups depending on their responses. For example, using 1-6 cigarettes a week was the threshold for classifying an individual as a smoker. Various other specific statistical techniques were used to explore the data, these are made clear by the authors in their paper.
Results
The authors original hypothesis that there is an association between social media exposure and use of e-cigarettes and smoking was confirmed. 2% of those who didn’t belong to social networking media were smokers, by contrast 15.7% of those who used social media for more than 7 hours a day smoked. This association was also confirmed for those using e-cigarette devices.
The research also found that parental smoking was associated with greater use of social media among young people.
There were also strong associations between e-cigarette use and those aged under 18, the legal age of purchase for these products. Also being male and from a higher income household increased the likelihood of using e-cigarettes.
15.7% of young people in the sample using social media more than 7 hours per day were also smokers, indicating a link between the two.
Conclusions
This study is the first to use longitudinal survey data from the United Kingdom that explores the association between use of social media and use of e-cigarettes and tobacco smoking. Overall, they found that greater use of social media was positively associated with all types of smoking.
The authors suggest that exposure to social media increases the probability of smoking as young people are targeted by the smoking industry. This is either by direct marketing or viewing social media influencers endorsing smoking.
The authors point to Germany which has been successful in banning social media platforms targeting young people to promote smoking in all its forms. They suggest the United Kingdom could also introduce such a policy making social media companies responsible for ensuring algorithms don’t target young people with advertising or other messages that promote smoking.
Male young people and those coming from higher income households were found more likely to use e-cigarettes.
Strengths and limitations
This is the first study to examine the relationship between smoking and use of social media among young people. The authors are candid about the limitations of their data and methods.
An obvious limitation is that this study relied in part on self-reported information. It is difficult to know how accurate the answers given to questions are without any independent scrutiny. It is interesting that those aged 10-15 years old had to be given permission by their parent or carer to complete the survey. Again, it is not clear how this may have influenced the data; if at all.
Participants were incentivised to take part and complete the questionnaire with gift vouchers, the authors don’t say how much these vouchers were worth. Using this method to encourage enrolment and completion of the survey might have had an influence on the way the questionnaire was completed by some individuals. Given the low response rate to surveys generally it is understandable why the researchers used gift vouchers to encourage uptake and completion of the survey. Higher response rates using gift vouchers could enhance rather than detract from the overall results. The authors included analysis that accounted for non-response bias.
We cannot be certain parental permission did not influence young people’s survey responses.
Implications for practice
It is worth thinking about how this study and its findings could help practitioners. This research helps us understand how important social media use is as an influence on all types of smoking among young people. In some ways that’s the easy part, the difficult aspect is what we do with this information. It would not be realistic to expect young people to refrain from social media in the hope this would reduce the risk of smoking.
What we do know is that there are aspects of frequent social media use that are also common in reward-seeking addictive behaviour. This might help practitioners consider whether these young people are also at risk of using drugs including alcohol in a problematic way. Clinicians should, therefore, not avoid questions around social media use and continuously explore associated risks in day-to-day life of young people, as information accessed online could negatively impact their wellbeing.
Clinicians need to consider whether young social media users could be at risk of other addictive behaviours as well as smoking.
Statement of interest
No conflicts of interests to declare.
Links
Primary paper
Hopkinson, N.S., Vrinten, C., Parnham, J.C., Radó, M.K., Filippidis, F., Vamos, E.P. and Laverty, A.A., 2024. Association of time spent on social media with youth cigarette smoking and e-cigarette use in the UK: a national longitudinal study. Thorax, 79(7), pp.662-669. https://doi.org/10.1136/thorax-2023-220569
Other references
E-cigarettes and teenagers, cause for concern? Mental Elf, 20th April 2015. Marcus Munafo.
