Healthy Vaping? Fitness-Oriented Imagery in Influencer E-Cigarette Marketing and Adolescent Perceptions of Influencers and E-Cigarettes

PurposeMicro-influencers (10,000 -100,000 followers) promote e-cigarettes in various contexts on social media. We assessed how e-cigarette promotion alongside fitness-oriented, healthy-lifestyle activities affects adolescent perceptions of e-cigarettes and micro-influencers.DesignRandomized experiment.SettingOnline survey.SampleCalifornia adolescents (N = 664, Mean age = 15) recruited in 2024.MeasuresAfter viewing each of 10 influencer videos, participants rated perceived influencer credibility (eg, honesty). After all videos, participants reported perceived harm, appeal, and susceptibility to use e-cigarettes.AnalysisParticipants were randomized to view 10 Instagram/TikTok posts of micro-influencers promoting e-cigarettes alongside fitness-oriented activities (treatment condition) vs micro-influencers promoting e-cigarettes without fitness-oriented imagery (control). Outcomes were compared between groups (treatment vs control) and between participants who perceived influencers as credible vs non-credible, using Cumulative Link Mixed Models.ResultsParticipants in the treatment condition were more likely to report lower e-cigarette harm perceptions (AOR = 1.15; 95% CI = 1.03-1.27), higher social appeal (AOR = 1.13; 95% CI = 1.02-1.25) and attractiveness (AOR = 1.21; 95% CI = 1.09-1.34) of e-cigarette use. Among those who perceived influencers as credible, participants in the treatment condition were more likely to report lower harm perceptions and higher social appeal, attractiveness, and fun of e-cigarette use.ConclusionMicro-influencer e-cigarette promotion alongside fitness-oriented activities, and perceptions of micro-influencers as credible, contributes to lower harm perceptions and higher appeal of e-cigarettes among adolescents.