Is Exposure to Social Media Advertising and Promotion Associated with E-cigarette Use? Evidence from Indonesia

Background: E-cigarette use is a growing public health concern globally, including in Indonesia. Objective: Our study aimed to assess whether exposure to advertising and promotion in social media is associated with e-cigarette use in Indonesia, an upper-middle-income country. Methods: We conducted mixed-method research including quantitative and qualitative methods. For the quantitative methods, we did an online survey in the five largest cities in the country with 1,239 participants during September-October 2020. For the qualitative method, we conducted an in-person focused group discussion during November 2020 (while complying to the COVID-19 protocols). Results: We found high rates of e-cigarette ever use (29%) and current use (13%) among study participants. There was high exposure to e-cigarette advertising and promotion in social media, with a majority of participants (84%) reported ever seeing e-cigarette adverts or promotions on Facebook, Instagram, YouTube, and others. Both high rates of e-cigarette use and exposure to social media advertising are associated. Participants reported ever seeing adverts and promotions were 2.91 times and 2.82 times more likely ever to use and currently use e-cigarettes, respectively, after controlling for socioeconomic factors, region, and cigarette smoking status. Conclusion: Exposure to social media advertising and promotion is associated with e-cigarette use in Indonesia