• Marissa J Smith and Shona Hilton.
• Medical Research Council and Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. Electronic address: marissa.smith@glasgow.ac.uk.
• Lancet. 2022 Nov 1; 400 Suppl 1: S77S77.

BackgroundEvidence suggests that experimentation and use of electronic cigarettes (e-cigarettes) is increasing. E-cigarettes are widely promoted on the internet, and user-generated content and influencer marketing on social media represents an important influence in shaping pre-adolescents and adolescents' understanding of issues and products. We aim to explore pre-adolescents and adolescents' responses to, and engagement with, e-cigarettes and the broader e-cigarette marketing environment, including user-generated and influencer content.Methods20 focus groups were conducted between March and May, 2022, with 82 pre-adolescents and adolescents aged 11-16 years living in the central belt area of Scotland, UK. Participants were asked about smoking and vaping behaviours, social media use, vaping advertisement exposure, and were shown illustrative examples of typical social media content (eg, images and videos), which were used to stimulate discussion about different messages, presentations, and contextual features. Focus groups were audio-recorded, transcribed verbatim, and coded by means of thematic analysis methods.FindingsParticipants mentioned seeing e-cigarette advertising mostly through social media platforms, such as Instagram and TikTok. Youths agreed that e-cigarettes portrayed on social media were often glamorised as being "cool", "fashionable", enticing by social media influencers, and viewed as a modern lifestyle accessory. Participants typically viewed e-cigarettes as less harmful than traditional cigarettes, but also expressed concerns about the scarcity of health and age warnings (ie, cautioning against use by individuals younger than 18 years) on social media, which was viewed as problematic, especially for younger children who spend time on these social media platforms. Participants stated that the adverts were branded to target their age group and that the e-cigarette flavourings encouraged youths to want to try the products, particularly sweet flavourings.InterpretationGiven the high level of pre-adolescents and adolescents' engagement with social media, these findings provide worrying evidence that e-cigarettes are attractive to this population group. Our findings suggest the growing need for governments to work together to develop and implement policies to restrict the advertising and marketing of e-cigarettes on social media. In addition, social media platforms should consider implementing more robust measures, such as age and health warnings, to ensure the prevention of vaping-related content targeted at underage users.FundingCancer Research UK, UK Medical Research Council, and UK Chief Science Office.Copyright © 2022 Elsevier Ltd. All rights reserved.

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