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The use of e-cigarettes is a growing public health concern. In 2019, 27.5% of US high school students reported current e-cigarette use.1 Marketing practices by e-cigarette companies may specifically appeal to adolescents2 and contribute to tobacco use–associated behaviors. Studies have indicated that cartoons are an effective strategy in increasing product recognition and susceptibility to use e-cigarettes.3 Recently, the US Food and Drug Administration announced it is prioritizing enforcement against e-cigarette companies that use marketing likely to promote youth use.4 This study aimed to determine if companies were using cartoon-based strategies to market and promote e-cigarette–associated products in 2019 on Instagram, an image-based social media platform popular among adolescents.
Prior research suggests the hashtag #ejuice is commonly used in e-cigarette–associated promotional posts on Instagram.2 As such, posts that contained this hashtag were scraped from Instagram between August 22 and September 12, 2019. All posts that remained publicly available at the time of analysis were included. Each Instagram post (image and corresponding caption) was reviewed and coded as to whether it contained (1) a cartoon, (2) promotional content, (3) a cartoon as the company’s logo, (4) the name of the company that used cartoons, and (5) Instagram user engagement data (ie, the number of likes the post received). Rules for coding were based on the Master Settlement Agreement definition of a cartoon (Box) and similar to prior research.2
A cartoon is defined as any drawing or other depiction of an object, person, animal, creature, or any similar caricature that satisfies any of the following criteria:
The use of comically exaggerated features;
The attribution of human characteristics to animals, plants, or other objects or the similar use of anthropomorphic technique; or
The attribution of unnatural or extrahuman abilities, such as imperviousness to pain or injury, x-ray vision, tunneling at very high speeds, or transformation.
Two coders were trained using a subsample of 1000 posts to establish interrater reliability. Agreement ranged from 70% to 90% for the coded categories. Any disagreements were resolved by a third coder (J.P.A.). Descriptive statistics were calculated, including the companies who most frequently used cartoons, and an independent t test was used to determine if Instagram user engagement (mean number of likes) differed between posts with vs without cartoon-associated content.
A total of 2100 posts were scraped, of which 1936 remained public at the time of analysis. One hundred forty-two of 1936 posts (7.3%) had 1 or more cartoons somewhere in the image, 1608 of 1936 posts (83.1%) were identified as promotions, and 44 of 1936 images (2.3%) were coded as a cartoon solely because of the logo. We identified 100 different companies that used cartoons in promotions (Figure), including Bang Juice (n = 9), Jam Monster (n = 6), Kenji Juice (n = 4), Dr Frost (n = 3), Vapetasia (n = 3), Nasty Juice (n = 3), Momo E-liquid (n = 3), and Mr Nik’s (n = 3), among others. Posts with cartoons received more likes (mean [SD], 133.94 [24.34] likes) compared with posts without cartoons (mean [SD], 72.41 [4.12] likes; P < .001).
Images used under license from Shutterstock.com.
Companies selling e-cigarettes used cartoons in their marketing and promotional practices on Instagram in 2019. Findings demonstrated that user engagement was higher among posts with cartoons, indicating cartoons’ appeal among users of Instagram. Logos and product packaging are known to have an association with consumers’ attitudes and behaviors,6 and adolescents are left vulnerable to these industry tactics. While the Master Settlement Agreement restricted the use of cartoons and youth-specific marketing tactics for combustible tobacco cigarette and chew companies,5 e-cigarette companies are not included in the agreement. The US Food and Drug Administration may take action against these companies, including through warning letters to injunction, seizure, and/or civil money penalty actions where warranted.4 While the current study could not determine the outcome of these promotional practices on e-cigarette appeal among adolescents, prior research3 has shown that recognition of cartoon-based imagery increased appeal of e-cigarette–associated products among young adults. Future research should determine how exposure to these marketing strategies affects perceived risks and benefits of e-cigarette use, intentions to use, and use among adolescents.
Accepted for Publication: February 26, 2020.
Corresponding Author: Jon-Patrick Allem, PhD, MA, Keck School of Medicine, University of Southern California, 2001 N Soto St, 3rd Floor, SSB K318, Los Angeles, CA 90032 (firstname.lastname@example.org).
Published Online: July 20, 2020. doi:10.1001/jamapediatrics.2020.1987
Author Contributions: Dr Allem and Ms Dormanesh had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: All authors.
Acquisition, analysis, or interpretation of data: Dormanesh, Allem.
Drafting of the manuscript: Dormanesh, Allem.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Dormanesh.
Obtained funding: Allem.
Conflict of Interest Disclosures: None reported.
Funding/Support: This project was supported by funds provided by the Regents of the University of California, Research Grants Program Office, Tobacco-Related Diseases Research Program (grant T30IR0891).
Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Disclaimer: The opinions, findings, and conclusions herein are those of the authors and not necessarily represent those of the Regents of the University of California or any of its programs.
Dormanesh A, Kirkpatrick MG, Allem J. Content Analysis of Instagram Posts From 2019 With Cartoon-Based Marketing of e-Cigarette–Associated Products. JAMA Pediatr. 2020;174(11):1110–1112. doi:10.1001/jamapediatrics.2020.1987
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