Social Influence in the Uptake and Use of Electronic Cigarettes: A Systematic Review.

Introduction:
This article is a systematic review of the role of social factors in the uptake of e-cigarettes. The review synthesizes evidence from experimental, longitudinal, and qualitative studies on the influence of social advertising, social interactions, and social norms on e-cigarette intentions and use. The review also examines the role of social media in amplifying or distorting the social factors that influence e-cigarette intentions and use.

Key Points:

* The review identified 43 studies that met the inclusion criteria, with most studies conducted in the US and published from 2011 onwards.
* All 9 experimental studies included in the systematic review examined the effect of advertising on e-cigarette intention, with 7 studies reporting that participants who were exposed to e-cigarette advertising had higher intention to use e-cigarettes post-intervention than participants in the control group.
* Longitudinal studies found associations between recall or receptivity to advertisements at baseline and initiation of e-cigarettes at follow-up.
* Qualitative studies explored participants' experiences and perceptions about initiation, intention, and continued use of e-cigarettes, with many participants reporting being exposed to e-cigarette ads in their daily lives and perceiving them as attractive, safe, and cool.
* Social connections, such as family, friends, and peers, were found to play a complex role in the decisions people make about e-cigarettes, with peer and friends' e-cigarette use associated with increased odds of initiation and continued use.
* Social norms related to the social acceptability of e-cigarettes were found to influence individual behavior, with interventions embedded in social networks showing promise in improving behavior outcomes.
* Social media was found to be an important conduit through which people engage with health information and the health-related attitudes and behaviors of their communities, with studies showing that interventions delivered via social media can promote changes in health behaviors.

Main Message:
The review highlights the important role of social factors, including advertising, social interactions, and social norms, in the uptake of e-cigarettes. While most studies focused on nonsmokers, there is a need for more primary research to measure how social factors affect smokers and nonsmokers differently. Given the increased popularity among nonsmokers and the potential for advertising to increase e-cigarette use, closer public health monitoring of e-cigarette uptake by nonsmokers is warranted. The review also underscores the need for regulatory approaches to advertising on social media to mitigate the risks of unregulated advertising and viral circulation of e-cigarettes to youth. Public health researchers and policymakers should consider interventions embedded in social networks to modify social norms and promote healthy behaviors, particularly among vulnerable populations like adolescents.

Amin S, Dunn AG, Laranjo L. Social Influence in the Uptake and Use of Electronic Cigarettes: A Systematic Review. American journal of preventive medicine. 2020;58(1):129-141. doi:10.1016/j.amepre.2019.08.023