Impact of Financial Disclosures and Health Warnings on Youth and Young Adult Perceptions of Pro-E-cigarette Instagram Posts

Abstract

Introduction

We examined the impact of financial disclosures and warning labels on pro-e-cigarette Instagram posts and their association with attitudes toward the ad and product among youth and young adults.

Methods

During March to May 2021, we conducted a factorial experiment using an online convenience sample of youth and young adults (N = 1687, M_age = 21.54). Participants were randomized to one of four conditions: pro-e-cigarette Instagram posts with only a financial disclosure, only a warning label, both a financial disclosure + warning label, or no financial disclosure or warning label. After viewing the posts, participants answered questions regarding their attitude toward the ad and the product. We used one-way ANOVA to estimate the association of condition on outcomes controlling for demographics.

Results

Young adults who viewed Instagram posts with only a financial disclosure reported more positive attitudes toward the ad than those who viewed posts with both a financial disclosure + warning label (p < .05). Young adults who viewed posts with only a financial disclosure reported more positive attitudes toward the product than those who viewed posts with only a warning label, both a financial disclosure + warning label, and without either (ps < .05). Differences were not statistically significant for youth. E-cigarette use status was associated with increased positive attitudes toward the ad (p < .001) and product (p < .001) for all participants.

Conclusions

Our results can inform policy interventions to mitigate the effects of e-cigarette social media marketing among youth and young adults. Including financial disclosures may not decrease appeal of e-cigarettes compared to posts without either.

Implications

Findings from the study suggest that a warning label may be more effective in reducing the effects of pro-e-cigarette social media posts than a financial disclosure among young adults. Public health officials should examine additional strategies beyond financial disclosures and warning labels (eg, social media peer mentoring program) to offset the persuasive effects of pro-e-cigarette social media marketing posts on young people. Additional policy interventional efforts are needed to limit the impact of e-cigarette social media marketing.

Introduction

In the United States, 11.0% of young adults¹ and 11.3% of high school students reported currently using e-cigarettes in 2021.² E-cigarette companies frequently employ influencer marketing on Instagram, which is an effective strategy that involves sponsoring young users to create user-generated content about the product on their personal accounts.³ The inclusion of financial disclosures (ie, a statement disclosing any financial relationship with a brand to be placed with the endorsement message)⁴ and health warning labels can reduce young people’s attention to pro-e-cigarette messages and mitigate the impact of e-cigarette social media advertising.^5–10 Furthermore, individuals are likely to respond to warnings and financial disclosures differently depending on their use of e-cigarettes.^5,6 The goal of this study was to examine the impact of financial disclosures and nicotine warning labels on perceptions of e-cigarette social media marketing.

Methods

Sample

Participants (N = 1687) were recruited from March to May 2021 using a convenience sample. We recruited youth (n = 752; between 14 and 17 years old) using the online survey data platform, Lucid (luc.id), and young adults (n = 935; between 18 and 29 years old) using Amazon Mechanical Turk (MTurk). Participants were eligible if they met the age requirements, spoke English, and were US citizens.

Study Design

After providing consent, participants self-reported demographics and tobacco use. Next, they were randomized to one of four conditions of Instagram posts promoting e-cigarettes: (1) with only a financial disclosure, (2) with only a warning label, (3) with both a financial disclosure + warning label, or (4) no financial disclosure or warning label. Each condition consisted of the same four real-world Instagram posts with young models promoting an e-cigarette product, which were modified to include or not include warnings and financial disclosures. Financial disclosures included a specific e-cigarette brand name, such as “This post was sponsored by JUUL,” and a hashtag indicating sponsorship such as “#ad” per the Federal Trade Commission recommendations. Warning labels were sized approximately 30% of the ad per the FDA e-cigarette warning label requirements (see Figure 1). Each of the four images within each assigned condition were presented for 10 seconds and followed by self-reported measures on attitudes toward the ads and the advertised e-cigarette products. Participants were compensated via Lucid’s and MTurk’s policies. All procedures were approved by the University of Oklahoma Health Sciences Center’s Institutional Review Board.

Figure 1.

Examples of study conditions. Real-life advertisements of Instagram influencers were adapted to create stimuli. For this publication, we have replaced the model image with a similar stock image. All other features (eg, username, comments, advertising condition texts) are the same as used in the experiment.

Measures

Demographics

Participants reported their age, sex assigned at birth, race and ethnicity, and household income.

E-cigarette Use

Participants were categorized as current users if they used e-cigarettes in the past 30 days (even one or two times), ever users if they had ever used e-cigarettes but not in the past 30 days, and never users if they had never used e-cigarettes.

Attitudes Toward the Ad

Attitudes toward the ad were assessed by using five items that asked about whether participants thought the ads were persuasive, interesting, attractive, would likely try to buy the product based on what they saw, and if overall they liked the ads.^11,12 Responses ranged from 1 (Strongly disagree) to 5 (Strongly agree), and items were summed and averaged across condition (Cronbach’s alphas > 0.86) to create a score. Higher scores indicated more positive attitudes.

Attitudes Toward the Product

Attitudes toward the advertised e-cigarette products were assessed using five items adapted from other scales that asked about whether participants were curious, can see themselves trying the product, can see themselves using it on their own, can see themselves using it with friends, and can see themselves buying the product shown.^13,14 Responses ranged from 1 (Strongly disagree) to 5 (Strongly agree). Items were summed by each post and averaged across the posts (Cronbach’s alphas > 0.95) to create a score. Higher scores indicated more positive attitudes toward products.

Statistical Analysis

All analyses were conducted using SPSS v.28. Descriptive statistics were used to describe the distributions of attitudes toward the ad and product. We used one-way ANOVA to estimate the main effects of condition and e-cigarette use status on attitudes toward the ads and products for each age group (youth and young adults). One-way ANOVA was appropriate for testing differences of the means of more than three predictor groups on the continuous outcome variables. Each age group (youth and young adults) was analyzed separately. We also estimated the interaction effects of condition and e-cigarette use status on outcomes for each age group. Finally, we examined the main effects of condition on the outcomes for e-cigarette never users for each age group. Models controlled for covariates (age in years, sex, race, ethnicity, and income).

Results

Youth

Participants

On average, participants were 16.02 years old (SD = 1.00), primarily female at birth (74.5%), White (52.4%), and non-Hispanic or Latino (76.5%), with household incomes above $35 000 per year (61.6%) and reported never having used e-cigarettes (56.4%).

Condition

The main effects of condition on attitudes toward the ads and product attitudes for youth were not statistically significant. Youth who viewed posts with a financial disclosure-only reported the highest mean scores on attitudes toward the ads and products, while those who viewed posts with only a warning label reported the lowest mean scores on attitudes toward the ads and products. However, the differences were not statistically significant.

E-cigarette Use

The main effects of e-cigarette use status on attitudes toward the ads were statistically significant (p < .001). Youth current users of e-cigarettes reported more positive attitudes toward the ads compared to those who were never users (p < .001) and ever users (p < .001), and ever users reported more positive attitudes toward the ads compared to never users (p < .001). The main effects of e-cigarette use status on product attitudes were also statistically significant (p < .001). Youth current users of e-cigarettes reported more positive attitudes toward the products compared to those who were never users (p < .001) and ever users (p < .001), and ever users reported more positive attitudes toward the products compared to never users (p < .001).

Among youth never users of e-cigarettes, the main effects of condition on attitudes toward the ads (p = .408) and products (p = .652) were not statistically significant.

Interaction Between Condition and E-cigarette Use

The interaction effects of condition and e-cigarette use on outcomes were not statistically significant.

See Table 1 for details.

Table 1.

Associations of Conditions and E-cigarette Use Status on Ad and Product Attitudes

Measure			M (SE)	F	p-value
Youth
Attitudes toward the ads	Condition	Financial disclosure-only	2.61 (0.12)	F(3,381) = 0.212	.888
		Warning label only	2.50 (0.08)
		No financial disclosure or warning label	2.55 (0.09)
		Both a financial disclosure + warning label	2.57 (0.19)
	E-cigarette use	Never user*	2.04 (0.05)	F(2,381) = 69.693	<.001
		Ever user*	2.58 (0.13)
		Current user*	3.05 (0.07)
	Condition × E-cigarette use			F(6,381) = 0.873	.515
Attitudes toward the product	Condition	Financial disclosure-only	2.43 (0.12)	F(3,381) = 0.240	.868
		Warning label only	2.33 (0.08)
		No financial disclosure or warning label	2.42 (0.09)
		Both a financial disclosure + warning label	2.37 (0.11)
	E-cigarette use	Never user*	1.56 (0.05)	F(2,381) = 189.694	<.001
		Ever user*	2.36 (0.13)
		Current user*	3.24 (0.07)
	Condition × E-cigarette use			F(6,381) = 1.821	.094
Young adults
Attitudes toward the ads	Condition	Financial disclosure-only*	2.75 (0.07)	F(3,853) = 3.049	.028
		Warning label only	2.56 (0.07)
		No financial disclosure or warning label	2.56 (0.07)
		Both a financial disclosure + warning label*	2.46 (0.07)
	E-cigarette use*	Never user*	2.12 (0.07)	F(2,853) = 88.930	<.001
		Ever user*	2.49 (0.06)
		Current user*	3.15 (0.04)
	Condition × E-cigarette use			F(6,853) = 1.077	.375
Attitudes toward the product	Condition*	Financial disclosure-only*	2.51 (0.07)	F(3,853) = 3.421	.017
		Warning label only*	2.29 (0.07)
		No financial disclosure or warning label*	2.24 (0.07)
		Both a financial disclosure + warning label*	2.22 (0.07)
	E-cigarette use	Never user*	1.61 (0.07)	F(2,853) = 193.855	<.001
		Ever user*	2.16 (0.06)
		Current user*	3.17 (0.05)
	Condition × E-cigarette use			F(6,853) = 0.872	.515

Positive attitudes were measured on a scale of 1 (Strongly disagree) to 5 (Strongly agree), with higher mean scores indicating stronger positive attitudes. Models adjusted for covariates (age, sex, race, ethnicity, and income). M = mean, SE = standard error. Pairwise comparisons showed statistically significant differences in attitudes toward the ad and product across all three e-cigarette user groups for youth and young adults. Pairwise comparisons showed statistically significant differences in the conditions on outcomes in young adults. Young adults in the financial disclosure-only condition reported significantly higher mean scores on attitudes toward the ad than those in the both a financial disclosure + warning label condition. Young adults in the financial disclosure-only condition reported significantly higher mean scores on attitudes toward the product than those in any other condition.

^*Denotes statistically significant differences at .05.

Young Adults

Participants

On average, participants were 25.99 years old (SD = 2.70), majority male sex (53.2%), primarily White (75.1%), and non-Hispanic or Latino (89.5%), with household incomes above $35 000 per year (74.2%) and reported having used e-cigarettes in the past 30 days (50.9%).

Condition

The main effects of condition on ad attitudes for young adults were statistically significant (p = .028). Young adults who viewed Instagram posts with only a financial disclosure reported more positive attitudes toward the ads than those who viewed posts with both financial disclosure + warning label (p = .003). The main effects of condition on product attitudes were statistically significant for young adults (p = .017). Young adults who viewed Instagram posts with only a financial disclosure reported more positive attitudes toward the products than those who viewed posts with only a warning label (p = .031), those who viewed posts with no financial disclosure or warning label (p = .007), and those who viewed posts with both financial disclosure + warning label (p = .004).

E-cigarette Use

The main effects of e-cigarette use status on ad attitudes were statistically significant (p < .001). Young adult current users of e-cigarettes reported more positive attitudes toward the ads compared to those who were never users (p < .001) and ever users (p < .001), and ever users reported more positive attitudes toward the ads compared to never users (p < .001). The main effects of e-cigarette use status on product attitudes were also statistically significant (p < .001). Young adult current users of e-cigarettes reported more positive attitudes toward the products compared to those who were never users (p < .001) and ever users (p < .001), and ever users reported more positive attitudes toward the products compared to never users (p < .001).

Among young adult never users of e-cigarettes, the main effects of condition on attitudes toward the ads were not statistically significant (p = .219), but the main effects of condition on attitudes toward the products were statistically significant (p = .034). Never users who viewed Instagram posts with only a financial disclosure reported more positive attitudes toward the products than those who viewed posts with only a warning label (p = .029), those who viewed posts with no financial disclosure or warning label (p = .005), and those who viewed posts with both financial disclosure + warning label (p = .020).

Interaction Between Condition and E-cigarette Use

The interaction effects of condition and e-cigarette use on outcomes were not statistically significant.

See Table 1 for details.

Discussion

This study examined youth and young adults’ perceptions of pro-e-cigarette Instagram posts within four conditions: posts with only a financial disclosure, only a warning label, both a financial disclosure + warning label, and no financial disclosure or warning label.

Our results suggest that the inclusion of a warning label (vs. financial disclosure) in pro-e-cigarette Instagram posts may be more effective in mitigating the effects of pro-e-cigarette posts for young adults. More work needs to be done to examine this association, as financial disclosures and warning labels may not be powerful enough to change e-cigarette attitudes or use intentions,⁸ at least not in a single exposure. Importantly, we found that ads with only a financial disclosure were less effective in reducing positive attitudes and product attitudes than ads with no financial disclosure or warning label. Our findings suggest that a financial disclosure should be used with discretion, and a financial disclosure is potentially effective only when combined with a warning label.

We did not detect significant associations of condition for youth, which suggests that while financial disclosures and warning labels may influence young adult perceptions on pro-e-cigarette social media posts to some degree,^7,8 more research is needed to understand how to mitigate these effects on youth. A potential explanation is that youth and young adults vary in their tobacco exposure and accessibility, including the surrounding environment (eg, school) and regulations (eg, legal tobacco purchase age), which distinctively influence their tobacco use behaviors.

Because youth and young adults are vulnerable to Instagram marketing, it is important to consider more factors beyond financial disclosures and warning labels that might mitigate persuasive e-cigarette content on social media.¹⁵ In this study, e-cigarette use status did not influence the effects of financial disclosures and warning labels. A potential explanation is the nature of warning labels and financial disclosures (ie, factual statement) that lack appealing features to effectively engage e-cigarette users and nonusers, thus limited in the ability to alter perceptions or react in ways that cigarette-smoking individuals would to anti-smoking messages. Our findings highlight opportunities for future research to investigate how psychosocial factors (eg, attitudes, beliefs) and peer influence¹⁵ may impact the associations between age and e-cigarette use status on young people’s responses to financial disclosures and warning labels. For instance, anti-tobacco campaigns may employ a peer mentoring program on social media to promote e-cigarette cessation among youth and young adults.¹⁶

This study has limitations. First, we did not measure whether perceptions of Instagram influencers may impact responses to the ads and products.¹⁷ Additionally, we did not examine whether age moderated the effects of condition on outcomes because we used different platforms to collect data on youth and young adults, thus unable to test for statistical differences in age groups. Despite these limitations, our study is among the first to provide key evidence on the impact of financial disclosures and warning labels on mitigating the effects of e-cigarette social media marketing among youth and young adults.

Conclusions

This study examined the impact of financial disclosures and warning labels on youth and young adult perceptions of pro-e-cigarette Instagram posts. Our findings indicate that those who saw financial disclosures reported more positive attitudes about the ads and products than those who saw posts with warning labels. Furthermore, those who saw financial disclosures reported more positive attitudes about the ads than those who saw posts without financial disclosures or warning labels. These findings provide preliminary evidence to inform policy interventional efforts to mitigate the impact of e-cigarette social media marketing.

Supplement Sponsorship

This article appears as part of the Nicotine & Tobacco Research supplement titled “Advances in Social Media Research to Reduce Tobacco Use,” sponsored by the National Cancer Institute and the NIH Office of Disease Prevention.

Funding

The study was funded by the Oklahoma Tobacco Settlement Endowment Trust (TSET) grant 092-016-0002. Data analysis and manuscript preparation were additionally supported by K01HL148907 (PI: APT) via National Heart, Lung, and Blood Institute and R00DA046564 (PI: ETH) and R00DA046563 (PI: EMS) via National Institute on Drug Abuse and 2T32CA172009 (DNL) via National Institutes of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Declaration of Interests

None declared.

Author Contributions

Donghee Lee (Formal analysis [lead], Writing—original draft [lead]), Meagan Bluestein (Formal analysis [supporting], Methodology [supporting], Writing—review & editing [equal]), Elise Stevens (Conceptualization [equal], Investigation [equal], Methodology [equal], Writing—review & editing [equal]), Alayna Tackett (Funding acquisition [lead], Writing—review & editing [equal]), Ashley Mathews (Visualization [lead]), and Emily Hébert (Conceptualization [lead], Methodology [lead], Resources [lead], Supervision [lead], Writing—review & editing [equal])

Data Availability

Data are available upon request.