DOI: https://doi.org/10.14710/jpki.21.1.26-34

Exposure to Electronic Cigarette Advertisements on the Internet and Smoking Behavior in Adolescents

*Diah Wijayanti Sutha orcid scopus  -  STIKES Yayasan RS Dr. Soetomo, Indonesia
Nathratul Ayeshah Binti Zulkifli  -  Faculty of Medicine and Health Science, Universiti Sains Islam, Malaysia
Christine Christine  -  Poltekkes Kemenkes Palu, Indonesia
Eka Wilda Faida  -  STIKES Yayasan RS Dr. Soetomo, Indonesia
Serlly Frida Drastyana  -  STIKES Yayasan RS Dr. Soetomo, Indonesia
Siti Novianti  -  Faculty of Health Science, Study Program of Public Health, Universitas Siliwangi, Indonesia
Open Access Copyright (c) 2026 Authors under http://creativecommons.org/licenses/by-sa/4.0.

Citation Format:
Abstract

Background: E-cigarettes are increasingly popular among adolescents, driven by massive advertising on the internet, especially through social media. These advertisements often display modern and attractive images without including sufficient information about health risks. Social media influencers also play a role in strengthening the appeal of e-cigarettes to adolescents. The purpose of this study is to analyze the relationship between exposure to e-cigarette advertising on the internet and smoking behavior among adolescents in Indonesia.

Method: This study used a cross-sectional design with an online survey conducted over three months, from March to June 2024. A total of 625 adolescents aged 14–19 years participated in this study. Respondents reported exposure to e-cigarette advertising on the internet, which was analyzed by age, gender, social media used, and smoking status. Data were analyzed using logistic regression to see the relationship between advertising exposure and smoking behavior.

Result The results showed that adolescents who were more frequently exposed to e-cigarette advertising were 2.3 times more likely to try e-cigarettes than those who rarely saw these advertisements. Instagram and YouTube were the main platforms where adolescents were exposed to e-cigarette advertisements. In addition, 50% of respondents reported seeing influencers using e-cigarettes, and 40.2% of them were interested in trying them. Most e-cigarette advertisements were also found not to include clear health warnings. This study confirms that exposure to e-cigarette advertisements on social media plays a significant role in increasing smoking interest and behavior in adolescents. Therefore, stricter regulations are needed for e-cigarette marketing on the internet, including supervision of the role of influencers and the obligation to include health warnings in every advertisement. In addition, broader health education is needed to increase adolescent awareness of the risks of e-cigarettes.

Fulltext View|Download
Keywords: electronic cigarette advertising;social media;adolescents;smoking behavior;advertising exposure

Article Metrics:

Article Info
Section: Research Article
Language : EN
Recent articles
Diffusion of Educational Digital Innovation: Implementing The OKY App for Menstrual Education in Junior High Schools Exploring the Impact of Lifestyle Habits and Environmental Factors on the Risk of Hypertension in Rural Populations Exposure to Electronic Cigarette Advertisements on the Internet and Smoking Behavior in Adolescents More recent articles
Most cited articles
Niat Tenaga Kerja Indonesia (TKI) di Jawa Tengah Dalam Upaya Mencegah Tertular HIV dan AIDS Pengaruh Perilaku Menggosok Gigi terhadap Plak Gigi Pada Siswa Kelas IV dan V di SDN Wilayah Kecamatan Gajahmungkur Semarang Faktor Sosial Budaya dalam Praktik Perawatan Kehamilan, Persalinan, dan Pasca Persalinan (Studi di Kecamatan Bangsri Kabupaten Jepara) Beberapa Faktor Yang Berpengaruh Terhadap Keluhan Nyeri Punggung Bawah Pada Penjual Jamu Gendong Faktor-Faktor Yang Berhubungan Dengan Praktik Wanita Pekerja Seks (WPS) Jalanan Dalam Upaya Pencegahan IMS Dan HIV/AIDS Di Sekitar Alun-Alun Dan Candi Prambanan Kabupaten Klaten More cited articles
  1. Glantz SA, Bareham DW. E-Cigarettes: Use, Effects on Smoking, Risks, and Policy Implications. Annu Rev Public Health. 2018;39(1):215–35
  2. Etter J-F. Gateway effects and electronic cigarettes. Addiction. 2018;113(10):1176–783
  3. Kemenkes RI. Profil Kesehatan Indonesia 2021 [Internet]. 2022. Available from: pusdatin.kemenkes.go.id
  4. Kemenkes RI. Hasil Utama Riskesdas 2018. [Internet]. 2022. Available from: https://repository.badankebijakan.kemkes.go.id/id/eprint/3514/1/Laporan%20Riskesdas%202018%20Nasional.pdf
  5. Chaffee BW, Couch ET, Urata J, Cash D, Werts M, Halpern-Felsher B. Electronic cigarette and moist snuff product characteristics independently associated with youth tobacco product perceptions. Tob Induc Dis. 2020;18(1):71
  6. Gao W, Chuluunbaatar E, Tsai M-K, Wen CP. Are e-cigarettes reviving the popularity of conventional smoking among Taiwanese male adolescents? A time-trend population-based analysis for 2004-2017. Tob Control. 2021;30(2):132–6
  7. Hammond D, Reid JL, Burkhalter R, Travers MB, Gravely S, Hyland A, et al. E-Cigarette Flavors, Devices, and Brands Used by Youths Before and After Partial Flavor Restrictions in the United States: Canada, England, and the United States, 2017‒2020. Am J Public Health. 2022;112(7):1014–24
  8. Eijk Y, Ping GTP, Ong SE, Xin GTL, Li D, Zhang D, et al. E-Cigarette Markets and Policy Responses in Southeast Asia: A Scoping Review. Int J Heal policy Manag. 2021;11(9):1616–24
  9. Bigwanto M, Muhammad F, Widad SM, Yudha L. Product variety and regulation avoidance in the sale of new tobacco products: findings from a point-of-sale survey in Indonesia. Subst Abuse Treat Prev Policy. 2022;17(1):78
  10. Eijk Y, Ping GTP, Ong SE, Xin GTL, Li D, Zhang, D, Shuen LM., Seng CK. The Case for Tightening E-Cigarette Regulations in Southeast Asia. Saw Swee Hock School of Public Health [Internet]. 2021. Available from: https://sph.nus.edu.sg/wp-content/uploads/2021/03/Tightening-E-Cigarette-Regulations-in-Southeast-Asia.pdf
  11. Kementrian Kesehatan. Profil Kesehatan Indonesia [Internet]. 2023. Available from: https://kemkes.go.id/id/profil-kesehatan-indonesia-2023
  12. Lee J, Suttiratana SC, Sen I, Kong G. E-Cigarette Marketing on Social Media: A Scoping Review. Curr Addict Reports. 2023;10(1):29–37
  13. Collins L, Glasser AM, Abudayyeh H, Pearson JL, Villanti AC. E-Cigarette Marketing and Communication: How E-Cigarette Companies Market E-Cigarettes and the Public Engages with E-cigarette Information. Nicotine Tob Res. 2019;21(1):2019
  14. Kong G, LaVallee H, Rams A, Ramamurthi D, Krishnan-Sarin S. Promotion of Vape Tricks on YouTube: Content Analysis. J Med Internet Res. 2019;21(6):12709
  15. Chen Y, Tilden C, Vernberg DK. Adolescents’ interpretations of e-cigarette advertising and their engagement with e-cigarette information: results from five focus groups. Psychol Health. 2020;35(2):163–74
  16. Wang Y, Duan Z, Weaver SR, Self-Brown SR, Ashley DL, Emery SL, et al. Association of e-Cigarette Advertising, Parental Influence, and Peer Influence With US Adolescent e-Cigarette Use. JAMA Netw Open. 2022;5(9):e2233938–e2233938
  17. Zheng X, Li W, Wong S-W, Lin H-C. Social media and E-cigarette use among US youth: Longitudinal evidence on the role of online advertisement exposure and risk perception. Addict Behav. 2021;119(1):106916
  18. WHO. WHO Report on The Global Tobacco Epidemic, 2021 (Addresing new and emerging product) [Internet]. Available from: https://www.who.int/publications/i/item/9789240032095
  19. Hoffmann JP. Social Learning, Social Bonds, Self-Control and Adolescent Nicotine Vaping. Subst Use Misuse. 2021;4:819–30
  20. Tapera R, Mbongwe B, Mhaka-Mutepfa M, Lord A, Phaladze NA, Zetola NM. The theory of planned behavior as a behavior change model for tobacco control strategies among adolescents in Botswana. PLoS One. 2020;15(6 June):1–13
  21. Horsburgh J, Ippolito K. A skill to be worked at: Using social learning theory to explore the process of learning from role models in clinical settings. BMC Med Educ. 2018;18(1):1–8
  22. Bandura A. Social cognitive theory of self-regulation. Organ Behav Hum Decis Process. 1991;50(2):248–87
  23. Liu L, Wang X. Is electronic cigarette more “healthy” than conventional cigarette? Perceptions, experiences, and social norm constructions among Chinese young adult vapers. J Ethn Subst Abuse. 2025;1–22
  24. Anderson M, Faverio M, Gottfried J. Teens, Social Media and Technology 2023 [Internet]. Available from: https://www.pewresearch.org/wp-content/uploads/sites/20/2023/12/PI_2023.12.11-Teens-Social-Media-Tech_FINAL.pdf
  25. Lozano-Blasco R, Mira-Aladrén M, Gil-Lamata M. Social Media Influence on Young People and Children: Analysis on Instagram, Twitter and YouTube. Comun Media Educ Res J. 2023;31(74):117–28
  26. Liu J, Wright C, Williams P, Elizarova O, Dahne J, Bian J, et al. Smokers’ Likelihood to Engage With Information and Misinformation on Twitter About the Relative Harms of e-Cigarette Use: Results From a Randomized Controlled Trial. JMIR public Heal Surveill. 2021;7(12):e27183
  27. Shrum, LawrenceJ. Cultivation theory: Effects and underlying processes [Internet]. 2017. Available from: https://onlinelibrary.wiley.com/doi/10.1002/9781118783764.wbieme0040
  28. Kalaji MNH. The Visual Is Worth Thousands of Words: Adult and Youth Perceptions of Visual Cues in e-Cigarette Advertising. Cornell University; 2022
  29. Reagan-Steiner S, Gary J, Matkovic E, Ritter JM, Shieh W-J, Martines RB. Pathological findings in suspected cases of e-cigarette, or vaping, product use-associated lung injury (EVALI): a case series. Lancet Respir Med. 2020;8(12):1219–32
  30. Kalininskiy A, Bach CT, Nacca NE, Ginsberg G, Marraffa J, Navarette KA. E-cigarette, or vaping, product use associated lung injury (EVALI): case series and diagnostic approach. Lancet Respir Med. 2019;7(12):1017–26
  31. Rosenstock IM. The Health Belief Model and Preventive Health Behavior. Health Education Monographs. 1974;2(4):354-386
  32. FDA. Cigarette Labeling and Health Warning Requirements [Internet]. 2024. Available from: https://www.fda.gov/tobacco-products/labeling-and-warning-statements-tobacco-products/cigarette-labeling-and-health-warning-requirements
  33. FDA. Advertising and Promotion [Internet]. 2018. Available from: https://www.fda.gov/tobacco-products/products-guidance-regulations/advertising-and-promotion
  34. Yan D, Wang Z, Laestadius L, Mosalpuria K, Wilson FA, Yan A, et al. A systematic review for the impacts of global approaches to regulating electronic nicotine products. J Glob Health. 2023;13(1)
  35. Jun J, Kim JK. Do state regulations on e-cigarettes have impacts on the e-cigarette prevalence? Tob Control. 2021;30(2):221–6
  36. Legleye S, Bricard D, Khlat M. Roles of parental smoking and family structure for the explanation of socio-economic inequalities in adolescent smoking. Addiction. 2023;118(1):149–59
  37. Tate C, Kumar R, Murray JM, Sanchez-Franco S, Montgomery SC, Montes F, et al. Socio-environmental and psychosocial predictors of smoking susceptibility among adolescents with contrasting socio-cultural characteristics: a comparative analysis. BMC Public Health. 2021;21(1):1–12
  38. Littlecott HJ, Moore GF, Evans RE, Melendez-Torres GJ, McCann M, Reed H, et al. Perceptions of friendship, peers and influence on adolescent smoking according to tobacco control context: a systematic review and meta-ethnography of qualitative research. BMC Public Health. 2023;23(1):1–21
  39. Patiño-Masó J, Font-Mayolas S, Salamó A, Arboix M, Sullman MJ. Predictors of intentions to use cigarettes and electronic-cigarettes among high school students. J Multidiscip Healthc. 2019;(2019):591–9

Last update:

No citation recorded.

Last update: 2025-09-29 13:30:40

No citation recorded.