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Exploring the Influence of Pro- and Anti-Tobacco Content in Social Media on Young Adults’ Tobacco Use Behaviors Open Access

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Young adults’ use of online social media sites is widespread, making social media a key source of exposure to pro- and anti-tobacco related content, including portrayals of smoking or messages discouraging smoking from peers. Different social media sites have different purposes, audiences, and norms, which may impact the influence social media use has on risk behaviors, including tobacco use. Additionally, peer influence through social media – given the ability of users to generate, share, and critique content – may heighten the impact tobacco-related content has on young adults’ tobacco use behaviors. This dissertation utilized survey data from a national sample of approximately 1,000 young adults age 18-24 to identify distinct patterns of social media site use and their relation to health risk behaviors, as well as to examine the relationship between exposure to tobacco-related content in social media and tobacco use behaviors. To further understand the experience of young adults consuming tobacco content in social media, in-depth interviews were conducted with eighteen smokers and nonsmokers. Young adults’ social media site use patterns fell into five distinct classes – distinguished by low use across all sites, high use across all sites, high use of a professionally focused site, high use of sites known for creative user generation of content, and high use of the most popular sites. These classes differed significantly in their use of alcohol, tobacco, and other drugs. Exposure to pro-tobacco content in social media was widespread (over 70%, either alone or in combination with anti-tobacco content), more common among smokers, and associated with openness to smoking among nonsmokers, social smoking among smokers with close friends who smoke, and use of cigars and hookah, but not cigarettes. The experiences of young adults shared in interviews support and further explain these quantitative findings, revealing the potential existence of distinct networks with differing tobacco use content and norms, with certain young adults (primarily low-income and minority smokers) reporting experiencing group norms that support taking pride in smoking, most young adults reporting experiencing group norms that frown upon taking pride in smoking but support social smoking (especially of cigars and hookah), and hardly any young adults reporting feeling supported in taking an anti-tobacco stance on social media. Young adults interviewed also assumed smoking posts influence their peers, potentially heightening the impact these posts have on their perceptions about the prevalence and acceptability of smoking. These differences in content and norms across networks of young adults might reinforce or even exacerbate existing disparities, as well as high rates of social smoking and use of cigars and hookah among young people. Overall, the results of this dissertation highlight the need for innovative social media interventions that disseminate preventive health information based on social media site use patterns associated with specific risk behaviors; target social smoking and cigar and hookah use; address norms related to the acceptability of smoking posts and the presumed influence posts have on peers; and purposefully leverage network characteristics to influence tobacco use behaviors.

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