Tobacco promotion is prolific on social media, with each platform setting their own restrictions on tobacco promotion and sales. We evaluated the policies related to tobacco product promotion and sales on 11 sites that are popular with youth in May 2021: Discord, Facebook, Instagram, Pinterest, Reddit, Snapchat, TikTok, Tumblr, Twitch, Twitter and YouTube. Nine of the 11 sites prohibitedpaid advertisingfor tobacco products. However, only three of them clearly prohibitedsponsored content(ie, social influencers) that promotes tobacco. Six platforms restricted content thatsells tobacco productsand three tried toprohibit underage accessto content that promotes or sells tobacco products. Although most platform policies prohibited paid tobacco advertising, few addressed more novel strategies, such as sponsored/influencer content and few had age-gating to prevent youth access. There is a pressing need to regulate tobacco promotion on social media platforms.

Nicotine pouches, dissolvable microfiber pouches prefilled with nicotine salt powder but not containing tobacco leaf, are gaining popularity in the US.¹ Nicotine concentration levels in these products are comparable to snus and moist snuff² and often exceed levels found in nicotine replacement therapy products,³ creating the potential for nicotine dependency instead of quitting among individuals who use nicotine and nicotine initiation or experimentation among those who are nicotine-naive.⁴ In this study, we assessed US nicotine pouch unit sales trends by volume and nicotine concentration levels.

Electric scooter (e-scooter) companies are growing in popularity across the United States looking to take advantage of the rideshare economy by providing an independent alternative to cars and bicycles. While e-scooter transportation could reduce emissions, and automobile congestion in local areas, powered two-wheeler drivers are extremely vulnerable to road risks. News reports of e-scooter crashes and fatalities have started to accumulate. Earlier research has demonstrated that the ways in which companies promote and demonstrate use of their product or service through social media influences consumer behavior. In the U.S. in 2018, this study examined the official Instagram account of Bird, the e-scooter market share leader with over 66,000 followers, to determine how much it emphasized safety in its posts. All posts to Bird's official Instagram account were collected from 22 September 2017 to 9 November 2018 (n = 324) and rules for coding content were developed. Among all posts, 69.14% contained a person visible with a Bird e-scooter, 6.17% contained persons wearing protective gear, 6.79% had protective gear somewhere in the post, and 1.54% of posts mentioned protective gear in the comment box. About 69.44% of the posts were reposts, and among reposts, 7.11% had persons wearing protective gear. Posts to Bird's official Instagram rarely showed e-scooters being used with protective gear. Photos of customers' experiences with Bird, via reposts, rarely featured protective gear potentially normalizing these behaviors among customers. Public health practitioners may need to establish interventions to promote use of protective gear while operating escooters.

Food purchasing and consumption behaviors have implications for nutrition and obesity. Food retail environments, in particular, shape customer food choices and energy intake. The marketing literature offers insights about how public health practitioners can work within food retail environments to encourage healthy food choices. We reviewed experimental studies in the marketing literature to examine factors influencing customer purchase intentions and choice for food products in retail stores. Database searches were conducted in February 2016 for original, empirical articles published in English from 2000–2015 in marketing journals. Each research article included at least one experimental design study conducted in a real or simulated retail environment with purchase intentions or choice of food products as an outcome variable. Backward and forward reference searches were conducted for articles meeting inclusion criteria. Narrative synthesis methods were used to thematically group and summarize the findings of forty-one articles that met inclusion criteria into three categories: shelf display and product factors, pricing and price promotion factors, and in-store and customer decision-making factors. This research contributes to the literature by providing specific and actionable approaches that can increase/decrease customer purchase intentions and choice for food products in retail environments. Translating marketing strategies into public health applications can provide recommendations for future intervention research and policy related to customer food purchasing behavior.

COVID-19 has changed the way people are living across the globe but will affect the health of specific populations more than others. Initial evidence suggests that older adults and individuals with preexisting medical conditions are more likely to develop problems with the virus.¹ Those with preexisting chronic respiratory conditions are an extremely vulnerable group,² and may include individuals who engage in behaviors (eg, smoking and vaping) that affect respiratory health.^1,3

Background: Public health organizations have begun to use social media to increase awareness of health harm and positively improve health behavior. Little is known about effective strategies to disseminate health education messages digitally and ultimately achieve optimal audience engagement. Objective: This study aims to assess the difference in audience engagement with identical antismoking health messages on three social media sites (Twitter, Facebook, and Instagram) and with a referring link to a tobacco prevention website cited in these messages. We hypothesized that health messages might not receive the same user engagement on these media, although these messages were identical and distributed at the same time. Methods: We measured the effect of health promotion messages on the risk of smoking among users of three social media sites (Twitter, Facebook, and Instagram) and disseminated 1275 health messages between April 19 and July 12, 2017 (85 days). The identical messages were distributed at the same time and as organic (unpaid) and advertised (paid) messages, each including a link to an educational website with more information about the topic. Outcome measures included message engagement (ie, the click-through rate [CTR] of the social media messages) and educational website engagement (ie, the CTR on the educational website [wCTR]). To analyze the data and model relationships, we used mixed effects negative binomial regression, z-statistic, and the Hosmer-Lemeshow goodness-of-fit test. Results: Comparisons between social media sites showed that CTRs for identical antitobacco health messages differed significantly across social media (P<.001 for all). Instagram showed the statistically significant highest overall mean message engagement (CTR=0.0037; 95% CI 0.0032-0.0042), followed by Facebook (CTR=0.0026; 95% CI 0.0022-0.0030) and Twitter (CTR=0.0015; 95% CI 0.0013-0.0017). Facebook showed the highest as well as the lowest CTR for any individual message. However, the message CTR is not indicative of user engagement with the educational website content. Pairwise comparisons of the social media sites differed with respect to the wCTR (P<.001 for all). Messages on Twitter showed the lowest CTR, but they resulted in the highest level of website engagement (wCTR=0.6308; 95% CI 0.5640-0.6975), followed by Facebook (wCTR=0.2213; 95% CI 0.1932-0.2495) and Instagram (wCTR=0.0334; 95% CI 0.0230-0.0438). We found a statistically significant higher CTR for organic (unpaid) messages (CTR=0.0074; 95% CI 0.0047-0.0100) compared with paid advertisements (CTR=0.0022; 95% CI 0.0017-0.0027; P<.001 and P<.001, respectively). Conclusions: Our study provides evidence-based insights to guide the design of health promotion efforts on social media. Future studies should examine the platform-specific impact of psycholinguistic message variations on user engagement, include newer sites such as Snapchat and TikTok, and study the correlation between web-based behavior and real-world health behavior change. The need is urgent in light of increased health-related marketing and misinformation on social media.