Promotion of Health-Harming Products on Instagram: Characterizing Strategies Boosting Audience Engagement with Cigar Marketing Messages.

Social media promotion of harmful products (e.g., combustible tobacco) poses a public health threat. However, strategies that amplify exposure to and engagement with such content remain understudied. This study aims to characterize strategies boosting cigar, little cigar, and cigarillo (CLCC) marketing visibility, referrals, and engagement on Instagram. Using keyword rules, we collected publicly available CLCC-related Instagram posts from CrowdTangle for a six-year period from August 2016 to October 2021. Posts were categorized as commercial (e.g., posts by tobacco brands or vendors) or organic and were coded for consumer engagement (CE) strategies (e.g., presence of prompts to like/share) using a combination of machine learning methods and human coding. Temporal engagement trends were analyzed using metadata. A total of 320,488 CLCC-related public posts were collected, with 44.6% ( = 142,875) identified as overtly commercial. Of these, 33.5% ( = 47,832) contained CE cues, including discounts and giveaways for tagging peers, liking, commenting, or following CLCC brands and spokesperson/influencers accounts, as well as calls to participate in contests and polls. Overtly commercial CE messages consistently garnered more comments per post and likes per post than non-CE commercial posts. There was a significant upward trend in the rate of comments on CE posts, suggesting growing effectiveness in eliciting user interaction. The proliferation of and high level of engagement with cigar-related promotional messages on Instagram demonstrate the need for public health surveillance and regulation of the evolving strategies promoting CLCC marketing exposure, reach, and engagement on social media.