Online Tobacco Advertising and Current Chew, Dip, Snuff and Snus Use among Youth and Young Adults, 2018–2019

Megan C. Diaz, Elexis C. Kierstead, Domonique Edwards, Yoonsang Kim, Shyanika W. Rose, Sherry Emery, Bushraa Khatib, Michael Liu, Ganna Kostygina

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objective: To understand the relationship between exposure to online tobacco advertising and current smokeless tobacco use in the context of tobacco control policies. Methods: Three waves of a national probability-based sample of (n = 15,985) youth and young adults were used. Analysis consisted of GEE logistic models controlling for social media use, demographics, tobacco use, average price of smokeless tobacco inclusive of taxes, smoke-free indoor air laws (SFIA) and state tobacco control expenditures. Results: Frequent exposure to tobacco advertising on social media is associated with greater odds of current smokeless use (aOR: 2.05, 95% CI: 1.62, 2.60). Higher prices and SFIA coverage were associated with reduced current smokeless use when examined separately from other tobacco policy variables (aOR: 0.79, CI: 0.73, 0.85; aOR: 0.44, CI: 0.28, 0.70). Conclusions: Greater exposure to tobacco advertising online is associated with greater odds of smokeless use among surveyed youth and young adults. This effect of social media marketing exposure on smokeless use outweighs the mitigating impact of existing tobacco control policies. The findings underscore the need for strong advertising regulation of evolving tobacco products, including smokeless products, on social media and surveillance of digital marketing tactics to young people.

Original languageEnglish
Article number4786
JournalInternational Journal of Environmental Research and Public Health
Issue number8
StatePublished - Apr 1 2022

Bibliographical note

Funding Information:
Funding: Research reported in this publication was supported by the National Institutes of Health and the National Cancer Institute under award number R01CA234082-01A1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.


  • policy
  • smokeless tobacco
  • social media
  • tobacco advertising

ASJC Scopus subject areas

  • Pollution
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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