Active and passive exposure to e-cigarette-related content online and patterns of tobacco use among U.S. adolescents:...

Most studies have examined exposure to e-cigarette-related content on social media without distinguishing between passive exposure and active engagement or considering broader patterns of tobacco and nicotine use. Distinguishing these forms of exposure allows clearer interpretation of whether associations reflect platform-driven content delivery or user interaction. This study identified the latent classes of tobacco and nicotine product use among U.S. adolescents (2021-2023) and examined the associations between passive and active exposure to e-cigarette content on social media and latent class membership.

Data were drawn from the 2021-23 U.S. National Youth Tobacco Survey (N_total = 70,773). Multigroup latent class analysis was used to identify tobacco use patterns across survey years. Multinomial logistic regression was used to examine the associations between passive (viewing e-cigarette-related content) and active (liking, commenting, or sharing such content) exposure and predicted class membership.

Three classes were identified: i) minimal/non-users (∼96%), ii) predominantly e-cigarette use (∼3%), and iii) poly-tobacco use (∼1%). Higher frequency passive exposure was associated with greater odds of predominantly e-cigarette use, while active engagement was associated with higher odds of both predominantly e-cigarette and poly-tobacco use, with stronger associations observed at higher exposure frequencies. Associations strengthened with increasing exposure frequency, with active engagement showing larger effect sizes, particularly for poly-tobacco use.

Distinguishing passive exposure from active engagement improves understanding of how adolescents' online interactions with e-cigarette content align with higher-risk tobacco use patterns.