{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:03:30Z","timestamp":1788959010246,"version":"build-2803163510"},"reference-count":31,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"\n Background<\/jats:title>\n Inhaling aerosolized nicotine and cannabis (colloquially called \u201cvaping\u201d) is prevalent among young adults. Instagram influencers often promote both nicotine and cannabis vaporizer products. However, Instagram posts discouraging the use of both products received national media attention during the 2019 outbreak of e-cigarette or vaping-associated lung injury (EVALI).<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This experiment tested the impact of viewing Instagram posts about EVALI, varying in image and text valence, on young adults\u2019 perceived harmfulness of nicotine and cannabis products, perceived risk of nicotine and cannabis vaporizer use, and intentions to use nicotine and cannabis vaporizers in the future.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Participants (N=1229) aged 18-25 (mean 21.40, SD 2.22) years were recruited through Qualtrics Research Services, oversampling for ever-use of nicotine or cannabis vaporizers (618\/1229, 50.3%). Participants were randomly assigned to view Instagram posts from young people portraying their experiences of EVALI in a 2 (image valence: positive or negative) \u00d7 2 (text valence: positive or negative) between-subjects experiment. Positive images were attractive and aesthetically pleasing selfies. The positive text was supportive and uplifting regarding quitting the use of vaporized products. Negative images and text were graphic and fear inducing. After viewing 3 posts, participants reported the perceived harmfulness of nicotine and cannabis products, the perceived risk of nicotine and cannabis vaporizer use, and intentions to use nicotine and cannabis vaporizers in the future. Ordinal logistic regression models assessed the main effects and interactions of image and text valence on perceived harmfulness and risk. Binary logistic regression models assessed the main effects and interactions of image and text valence on intentions to use nicotine and cannabis vaporizers. Analyses were adjusted for product use history.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Compared to viewing positive images, viewing negative images resulted in significantly greater perceived harm of nicotine (P=.02 for disposable pod-based vaporizers and P=.04 for other e-cigarette \u201cmods\u201d devices) and cannabis vaporized products (P=.01), greater perceived risk of nicotine vaporizers (P<.01), and lower odds of intentions to use nicotine (P=.02) but not cannabis (P=.43) vaporizers in the future. There were no significant main effects of text valence on perceived harm, perceived risk, and intentions to use nicotine and cannabis vaporized products. No significant interaction effects of image and text valence were found.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Negative imagery in Instagram posts about EVALI may convey the risks of vaporized product use and discourage young adults from this behavior, regardless of the valence of the post\u2019s text. Public health messaging regarding EVALI on Instagram should emphasize the risk of cannabis vaporizer use, as young adults may otherwise believe that only nicotine vaporizer use increases their risk for EVALI.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/46153","type":"journal-article","created":{"date-parts":[[2023,8,8]],"date-time":"2023-08-08T03:10:14Z","timestamp":1691464214000},"page":"e46153","source":"Crossref","is-referenced-by-count":7,"title":["Young Adults\u2019 Perceptions of and Intentions to Use Nicotine and Cannabis Vaporizers in Response to e-Cigarette or Vaping-Associated Lung Injury Instagram Posts: Experimental Study"],"prefix":"10.2196","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0005-7299","authenticated-orcid":false,"given":"Karla D","family":"Llanes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6166-9347","authenticated-orcid":false,"given":"Pamela M","family":"Ling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9765-2299","authenticated-orcid":false,"given":"Jamie","family":"Guillory","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7193-8720","authenticated-orcid":false,"given":"Erin A","family":"Vogel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2023,9,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6946a4"},{"key":"ref2","unstructured":"SchulenbergJEPatrickMEJohnstonLDO'MalleyPMBachmanJGMiechRAUniversity of Michigan, Institute for Social Research20212023-08-10https:\/\/deepblue.lib.umich.edu\/handle\/2027.42\/150623"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1105249"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.8950"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2019.2574"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6903e2"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6836e2"},{"key":"ref8","unstructured":"Outbreak of lung injury associated with the use of e-cigarette, or vaping, productsCenters for Disease Control and Prevention20202023-08-10https:\/\/www.cdc.gov\/tobacco\/basic_information\/e-cigarettes\/severe-lung-disease.html#map-cases"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1916433"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6845e1"},{"key":"ref11","unstructured":"Social media use in 2021 a majority of Americans say they use YouTube and Facebook, while use of Instagram, Snapchat and TikTok is especially common among adults under 30Pew Research Center20212023-08-10https:\/\/www.pewresearch.org\/internet\/wp-content\/uploads\/sites\/9\/2021\/04\/PI_2021.04.07_Social-Media-Use_FINAL.pdf"},{"key":"ref12","unstructured":"DucharmeJSocial media helped Juul dominate the vaping market. 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