Purba Amrit Kaur, Henderson Marion, Baxter Andrew, Pearce Anna, Katikireddi S Vittal
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK.
Nicotine Tob Res. 2025 Mar 24;27(4):693-704. doi: 10.1093/ntr/ntae057.
To estimate the effect of social media use in 14 year olds on risk of and inequalities in cigarette, e-cigarette, and dual use at 17 years, using the UK-representative Millennium Cohort Study (born 2000-2002).
The relationship of time spent on social media (using questionnaires [n = 8987] and time-use-diaries [n = 2520]) with cigarette, e-cigarette, and dual use was estimated using adjusted odds ratios (AORs) or relative risk ratios (ARRRs). Effect modification was examined (using parental education as an indicator for socioeconomic circumstances) by comparing adjusted risk differences within low and high-parental education groups. Analyses accounted for prespecified confounders (identified via directed acyclic graphs), baseline outcome measures (to address reverse causality), sample design, attrition, and item-missingness (through multiple imputation).
Time spent on social media was associated with increased risk of cigarette, e-cigarette, and dual use in a dose-response manner. Social media use for ≥2 hours/day (vs. 1-<30 minutes) was associated with increased cigarette (AOR 2.76 [95% confidence interval 2.19 to 3.48]), e-cigarette (3.24 [2.59 to 4.05]), and dual use (ARRR 4.11 [2.77 to 6.08]). The risk of cigarette use among 30 minutes-<1 hour/day users (vs. non-users) were smaller in those with high versus low parental education (ARDs 1.4% vs. 12.4%). Similar findings were observed across the higher time categories. Analyses using time-use-diaries, in complete case samples, and with additional adjustment for baseline outcome measures generally revealed similar findings.
After accounting for observed confounders and potential reverse causality, findings suggest social media use increases the risk of cigarette, e-cigarette, and dual use in a dose-response manner. Guidance addressing adolescent online safety should be prioritized.
This study's identification of a dose-response relationship and differential effects across socioeconomic groups, could assist in the development of guidance on time spent on social media. The adverse effects of social media use on adolescent cigarette, e-cigarette, and dual use supports legislation aimed at promoting adolescent online safety. Study findings strengthen calls to prohibit social media marketing of nicotine-related products and importantly highlight the need to increase awareness and understanding of the underlying algorithms which drive adolescent exposure to nicotine-related content on social media to ensure they are functioning in a way that best serves the adolescent population.
利用具有英国代表性的千禧队列研究（出生于2000 - 2002年），评估14岁青少年使用社交媒体对其17岁时吸烟、吸电子烟及双重使用（两种都吸）风险和不平等情况的影响。
使用调整后的优势比（AOR）或相对风险比（ARRR）评估在社交媒体上花费的时间（通过问卷调查[n = 8987]和时间使用日记[n = 2520]）与吸烟、吸电子烟及双重使用之间的关系。通过比较父母教育程度低和高的两组内调整后的风险差异，检验效应修正（以父母教育程度作为社会经济状况的指标）。分析考虑了预先设定的混杂因素（通过有向无环图确定）、基线结局测量（以解决反向因果关系）、样本设计、损耗以及数据缺失（通过多重填补）。
在社交媒体上花费的时间与吸烟、吸电子烟及双重使用风险的增加呈剂量反应关系。每天使用社交媒体≥2小时（与1 - <30分钟相比）与吸烟风险增加相关（AOR 2.76 [95%置信区间2.19至3.48]）、吸电子烟风险增加（3.24 [2.59至4.05]）以及双重使用风险增加（ARRR 4.11 [2.77至6.08]）。父母教育程度高的人群中，每天使用社交媒体30分钟 - <1小时的使用者（与不使用者相比）吸烟风险低于父母教育程度低的人群（风险差异分别为1.4%和12.4%）。在更高的时间类别中也观察到类似结果。使用时间使用日记、完整病例样本以及对基线结局测量进行额外调整的分析通常得出类似结果。
在考虑了观察到的混杂因素和潜在的反向因果关系后，研究结果表明使用社交媒体会以剂量反应方式增加吸烟、吸电子烟及双重使用的风险。应优先制定针对青少年网络安全的指导方针。
本研究确定的剂量反应关系以及社会经济群体间的差异效应，有助于制定关于在社交媒体上花费时间的指导方针。使用社交媒体对青少年吸烟、吸电子烟及双重使用的不利影响支持旨在促进青少年网络安全的立法。研究结果强化了禁止社交媒体对尼古丁相关产品进行营销的呼吁，并且重要的是突出了提高对驱动青少年接触社交媒体上尼古丁相关内容的底层算法的认识和理解的必要性，以确保这些算法以最有利于青少年群体的方式运行。
