Exposure to tobacco and betel nut content on social media, risk perceptions, and susceptibility to peer influence among early adolescents in Guam.

Introduction: This study aimed to examine the associations between exposure to tobacco and betel nut-related content on social media, perceived risks of tobacco and betel nut use, and susceptibility to peer influence for tobacco and betel nut use among adolescents living in Guam, a United States-Affiliated Pacific Island in the Western Pacific. Methods: A representative survey of adolescents (N = 670) attending public middle schools on Guam was conducted. The survey measured exposure to tobacco and betel nut content on the following social media platforms: (a) Facebook, (b) Twitter, (c) Instagram, (d) Snapchat, and (e) WhatsApp. The survey also measured perceived risks of tobacco and betel nut use and susceptibility to peer influence for tobacco and betel nut use. Results: Guam adolescents' exposure to tobacco-related content on social media was found to be associated with lower perceived risks toward the use of tobacco (ß = -0.18, p < 0.001) and betel nut (ß = -0.16, p < 0.001). Also, exposure to tobacco-related content on social media was found to be associated with higher levels of susceptibility to peer influence for uses of both tobacco (ß = 0.10, p < 0.05) and betel nut (ß = 0.15, p < 0.001). Similarly, exposure to betel nut-related content on social media was associated with lower perceived risks of using betel nut (ß = -0.20, p < 0.001) and tobacco (ß = -0.24, p < 0.001). Also, exposure to betel nut-related content on social media was associated with increased susceptibility to peer influence for use of both betel nut (ß = 0.35, p < 0.001) and tobacco (ß = 0.29, p < 0.001). Conclusions: Adolescents' exposure to tobacco- and betel nut-related content on social media may influence attitudinal risk factors associated with tobacco and betel nut use.

Social media, peer norms, and betel nut susceptibility and use: Evidence from early adolescents in Guam.

Betel (areca) nut is an addictive psychoactive substance considered to be carcinogenic. Yet not much is known about factors that may be promoting betel nut use. To fill this void, the present study examines the roles of exposure to betel nut-related posts on social media and peer norms regarding betel nut use in explaining betel nut susceptibility and use among adolescents. We conducted a representative survey of early adolescents (N = 673) attending all public middle schools on Guam, a United States-Affiliated Pacific Island in the Western Pacific. Results showed that exposure to betel nut-related posts on social media was positively associated with peer descriptive norms regarding betel nut use. Specifically, the more frequent early adolescents were exposed to betel nut posts on social media, the more likely they were to perceive betel nut use to be more prevalent among their general peers and close friends. Additionally, early adolescents' exposure to betel nut-related posts on social media was positively associated with both their susceptibility to use betel nut and reported use. Descriptive norms regarding close friends' betel nut use was also positively associated with both susceptibility to and use of betel nut. However, descriptive norms regarding general peers' betel nut use was unrelated with either betel nut susceptibility or use. Descriptive norms regarding close friends' betel nut use mediated the relationships that exposure to betel nut posts on social media had with both betel nut susceptibility and betel nut use. Implications are discussed.

Social media's influence on e-cigarette use onset and escalation among young adults: What beliefs mediate the effects?

As an extension of a previous cross-sectional study, this study employed prospective data to test positive outcome expectancy beliefs as mediators of social media's influence on e-cigarette use progression among young adults. Self-report data were collected from 2327 young adult college students (Mean age = 21.2; SD = 2.1; 54% women) between 2017 and 2019, every 6-month, at 3 time-points. Structural equation modeling was used to test the mediational models. Among baseline never e-cigarette users, higher affect regulation expectancies-e.g., beliefs that e-cigarette use results in feeling good, reduced boredom and stress-mediated the effects of higher baseline social media e-cigarette exposure on e-cigarette use onset one year later. Among baseline lifetime e-cigarette users, higher positive sensory, positive "smoking" experience, and affect regulation expectancy beliefs mediated the effects of higher social media e-cigarette exposure at baseline on increased current e-cigarette use one year later. E-cigarette content on social media may persuade young adults to try e-cigarettes by imparting the sense that e-cigarettes make one feel good and help reduce stress. E-cigarette content on social media that promote e-cigarette flavors and e-cigarettes as cleaner and a socially more acceptable alternative to cigarettes may work to escalate e-cigarette use among experimenters. Efforts to prevent e-cigarette use onset and escalation may need to target the outcome expectancy beliefs influenced by social media.

An Instagram-Based Study to Understand Betel Nut Use Culture in Micronesia: Exploratory Content Analysis.

BACKGROUND: A 2012 World Health Organization report recognizes betel nut use as an urgent public health threat faced by the Western Pacific region. However, compared with other addictive substances, little is known about how betel nuts are depicted on social media platforms. In particular, image-based social media platforms can be powerful tools for health communication. Studying the content of substance use on visual social media may provide valuable insights into public health interventions. OBJECTIVE: This study aimed to explore and document the ways that betel nut is portrayed on the photo-sharing site Instagram. The analysis focuses on the hashtag #pugua, which refers to the local term for betel nut in Guam and other parts of Micronesia. METHODS: An exploratory content analysis of 242 Instagram posts tagged #pugua was conducted based on previous research on substance use and Instagram and betel nut practices in Micronesia. In addition, the study examined the social engagement of betel nut content on the image-based platform. RESULTS: The study findings revealed content themes referencing the betel nut or betel nut tree, betel nut preparation practices, and the unique social and cultural context surrounding betel nut activity in Guam and Micronesia. In addition, certain practices and cultural themes encouraged social engagement on Instagram. CONCLUSIONS: The findings from this study emphasize the cultural relevance of betel nut use in Micronesia. These findings provide a basis for empirically testing hypotheses related to the etiological roles of cultural identity and pride in shaping betel nut use behavior among Micronesians, particularly youths and young adults. Such research is likely to inform the development of culturally relevant betel nut prevention and cessation programs.

Tradition Gone Mobile: An Exploration of #Betelnut on Instagram.

Background: As a psychoactive substance that spans borders and cultures, researchers estimate that 600 million people use the areca nut. Despite its historical and geographical significance, betel nut use has received far less research attention than other stimulants such as tobacco, coffee or tea. Scholars have observed that social media platforms have significant effects on the promotion and use of addictive substances. Objectives: Our study investigates user practices and activities on a sample of Instagram posts tagged #betelnut dating back to 2011. Methods: Using social media analytics and hashtag network analysis, we examined user practices and activities on a sample of over 7800 Instagram posts tagged #betelnut dated between July 2011 to February 2019 that were collected in early 2019. Results: Findings determined that #betelnut is a growing topical hashtag on Instagram with content that drives social engagement. Importance: Co-occurring hashtags with #betelnut reflect regional language and cultural naming conventions that center around the Indian subcontinent and Melanesia. The importance of future work in this area is highlighted.

Adolescent betel nut use in Guam: beliefs, attitudes and social norms.

Betel (areca) nut is an addictive substance chewed with or without tobacco widely in Asia and the Pacific, including the U.S.-affiliated Pacific Islands (USPI). Betel nut use has been found to cause oral cancer. Research suggests that most betel nut use initiation occurs in adolescence. However, very little is currently known about the etiology of adolescent betel nut use. The present study reports findings of a formative, qualitative research conducted to understand the attitudinal and social factors associated with adolescent betel nut use in USAPI. The objective was to develop a theoretical framework of adolescent betel nut etiology that would guide the development of a prevention program. Semi-structured interviews were conducted with 20 adolescent betel nut users (M age = 14.5; SD = 2.2) from Guam. Findings suggested a framework of adolescent betel nut etiology in which intrapersonal, social, and environmental factors influence betel nut use behavior. The framework is consistent with ecological frameworks of adolescent substance use in which proximal personal and social influences on adolescent substance use occur within the context of a wider socio-cultural context conducive to adolescent substance use. Specifically, we found that beliefs such as betel nut tastes good and induces relaxation represent some of the betel nut use motives; parental permissiveness and peer and sibling use encourage betel nut use; and cultural acceptance and easy accessibility to betel nuts provide an environmental context conducive to betel nut use. Findings are discussed in the context of developing an adolescent betel nut use prevention program.

Adolescent Tobacco and Betel Nut Use in the US-Affiliated Pacific Islands: Evidence From Guam.

PURPOSE: To determine the prevalence of, and the risk and protective factors associated with, tobacco product use among adolescents in Guam, a US-Affiliated Pacific Island (USAPI) territory. To examine disparities in risk and protective factors across indigenous and nonindigenous groups. DESIGN: Quantitative; cross-sectional. SETTING: Middle and high schools in Guam. SAMPLE: The Global Youth Tobacco Survey sample included a representative sample of 2449 6th to 12th graders (71% response rate). Sample for the supplemental study included 670 middle school students (76% response rate across randomly selected classrooms). MEASURES: Self-reported measures of lifetime and past 30-day tobacco and betel nut use, social competence, resistance self-efficacy, risk perceptions, friend and family tobacco product use, and ease of access to tobacco products. ANALYSIS: Multilevel logistic regression and analysis of covariance. RESULTS: The prevalence rates of current cigarette, smokeless tobacco, and e-cigarette use among middle school students were 8%, 8%, and 25%, respectively. Ability to resist social pressure to use tobacco/betel nut use was strongly associated with lower likelihood of tobacco (odds ratio [OR] = 0.76; 95% confidence interval [CI]: 0.68-0.84) and betel nut use (OR = 0.74; 95% CI: 0.67-0.82). Indigenous Pacific Islanders scored significantly lower on protective and higher on risk factors. CONCLUSION: Tobacco product use rates among Guam middle school students appear to be 4 to 5 times higher than the US national average rates. There is an urgent need for developing tobacco and betel nut use prevention programs for USAPI youth that are tailored to the needs of indigenous Pacific Islanders.

Social media e-cigarette exposure and e-cigarette expectancies and use among young adults.

A vast majority of U.S. young adults use social media such as Facebook and Instagram daily. Research suggests that young adults are commonly exposed to e-cigarette-related marketing or user-generated content on the social media they use. Currently, however, there is limited empirical evidence as to how social media e-cigarette exposure is associated with e-cigarette use beliefs and behavior. In particular, limited evidence exists to support the proposition that social media e-cigarette exposure is uniquely associated with e-cigarette use, even after adjusting for the effects of e-cigarette use in young adults' in-person or 'offline' social networks. This study was conducted to test the hypotheses that 1) social media e-cigarette exposure is associated with e-cigarette use outcome expectancies and current e-cigarette use; and 2) the association between social media and e-cigarette use is linked via outcome expectancies. We collected cross-sectional data from a sample of 470 young adult college students in Hawaii. Hypotheses were tested by fitting a structural equation model to the data. The model accounted for the associations of demographic variables, cigarette smoking history, as well as e-cigarette use in individuals' actual social networks with expectancies and behavior. Results indicated that social media e-cigarette exposure was associated with current e-cigarette use indirectly through two of the four positive outcome expectancies examined, namely, positive "smoking" experience and positive sensory experience. We discuss the implications of the findings in the context of tobacco control efforts.