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Social media use among adolescents and young adults was associated with a higher likelihood of smoking and vaping, a national longitudinal study from the U.K. found.

In individuals ages 10 to 25 years, even those who spent less than an hour each day on social media were more likely to smoke cigarettes than those who did not use social media at all (adjusted odds ratio [aOR] 1.92 95% CI 1.43-2.58). And at least 1 to 3 hours a day on social media was linked with increased use of vaping (aOR 1.92, 95% CI 1.07-3.46).

But the odds more than doubled for youth who spent 7 or more hours on social media each day versus those who did not use social media at all:

• Cigarette smoking: aOR 3.60 (95% CI 2.61-4.96)
• Vaping: aOR 2.73 (95% CI 1.40-5.29)
• Dual use: aOR 4.96 (95% CI 1.71-14.34)

"This association was independent of other factors associated with increasing smoking and vaping including age, gender, socioeconomic status, and parental smoking and vaping," wrote Anthony Laverty, PhD, of Imperial College London School of Public Health, and coauthors in .

The researchers pointed to a number of possible explanations for their findings.

First, evidence shows that cigarette and vaping companies use , including via "direct advertising which is algorithmically targeted and the use of paid social media influencers who present smoking and vaping as a fashionable and desirable activity," they noted.

"Second, social media use has been shown to have features in common with reward-seeking addictive behaviour. High social media use may increase susceptibility to other addictive behaviors like smoking," they continued. "Third, as a space that is largely unsupervised by parents/caregivers, social media use may encourage behaviours that are transgressive, including cigarette smoking and vaping."

Despite the potential health risks, recent research has indicated that social media is more likely to promote a positive view of vaping. Furthermore, social media influencers relationships with e-cigarette companies when they post content featuring these products.

"The policy implications of this paper are important, particularly as they pertain to regulation of advertising and algorithms targeting under-age users," wrote Kim Lavoie, PhD, of the University of Quebec in Montreal, in an .

"The fact that previous research indicates that youth are indeed targeted by this content, that this content is reaching youth (32% of youth report having seen vape products advertised online) and their attitudes are impacted, is further evidence of the need to strengthen regulation," according to Lavoie.

In a , study co-author Nicholas Hopkinson, MD, PhD, also of Imperial College London, said that cigarette and vaping promotion on social media often takes different forms than traditional advertising, making it more difficult to regulate.

"Because it's done in a more sort of organic way, where it's with influencers -- it's harder to pin down where the laws are being broken," he said. "But it's important to come back to the fact that what we see on social media is curated for us by algorithms, so social media companies can control this if they choose to. It may be costly for them, it may be something they need to be compelled to do."

Data for the study was taken from the U.K. Household Longitudinal Study and included a total of 10,808 participants ages 10 to 25 years from 27,962 surveys taken from 2015 to 2021. Participants were asked about their social media use as well as current cigarette or vaping activity.

Of the respondents, 8.6% reported current cigarette smoking, 2.5% reported current e-cigarette use, and 1.1% reported current dual use during at least one time point. Current cigarette and vaping use, respectively, was consistently higher among those who logged more hours each day on social media:

• 0 hours: 2% and 0.8%
• <1 hour: 6.3% and 2%
• 1-3 hours: 9.2% and 2.4%
• 4-6 hours: 12.2% and 3.8%
• ≥7 hours: 15.7% and 4%

Dual use followed a similar pattern, ranging from 0.3% to 2%.

Males were less likely to be in higher groups of social media use, and social media use was more frequent among the older individuals in the study. Parental cigarette smoking or e-cigarette use was more commonly reported among the adolescents and young adults who used social media more frequently.

Laverty and colleagues noted that the analysis relied on self-reported data, which may potentially limit the findings. Additionally, there was no information about how participants used social media, whether users were exposed to cigarette or vaping ads, and the researchers were unable to assess how the various platforms might be associated with cigarette or vaping use.

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