The FDA is losing the war on vaping to Instagram influencers

The United States' Food and Drug Administration's "#TheRealCost" of vaping video ad campaign is so full of special effects it looks more like a Marvel trailer than a public health ad. But despite the whiz-bang aesthetics, new research suggests the campaign isn't reaching the people that stand to lose the most from the habit.

Record numbers of teenagers have picked up vaping in the last three years. That surge happened despite the FDA's "#TheRealCost" of vaping campaign, which features disturbing images of vaping teenagers with alien-like bulging veins. It looks similar to the Mindflayer leaving the body of Will Byers in season two of Stranger Things. But the new analysis reveals that the message isn't resonating with teenagers on one of the platforms they use the most — Instagram.

Here's the ad so that you can watch for yourself:

Combing through 245,894 Instagram posts featuring vaping-related hashtags (think #ejuice or #vape), reveals that the FDA's #TheRealCost hashtag was only used about 50 times per month. Hashtags that mention vaping in a positive way were used about 10,000 times more often. The results suggest Instagram's "vaping influencers" are drowning out the FDA's message on social media, says Julia Vassey, the study's first author and a researcher at the University of California, Berkeley.

The pro-vaping message on social appears to arise organically — not just via paid influencers. Instagram has banned paid vaping influencers and JUUL shuttered their Instagram and Facebook accounts after pressure from the FDA in 2018. But despite these measures to counter pro-vape posts, the content still dominates the conversation.

"My understanding is that Instagram is planning to go after paid influencers, but there are so many organic Influencers or those who do not disclose their sponsorship on Instagram that in my opinion makes it hard to control all this content," Vassey tells Inverse.

"JUUL is one big well-known company compared to thousands of vaping influences with a number of followers ranging from 10 to millions of users," she says.

The study was published Tuesday in the journal Frontiers in Communication.

Organic influencers

The analysis found that pro-vaping content outnumbers the FDA's content by some 10,000 to one. An additional analysis of a representative sample of 1,000 posts shows that "e-juice" is one of the most commonly marketed things on social media: 60 percent of the pro-vape posts were about e-juice. And though flavored pod systems have now been banned by the US government, other types of open-tank flavored e-juices are still legal.

Not only are they still legal, but they are everywhere on Instagram. Posts that promote candy, fruit, and cookie flavor e-juice are still circulating under the #ejuice hashtag, and previous research has shown that these flavors are particularly enticing to teens.

E-juice aside, the pro-vaping content on social media appears to have drowned out the message that vaping isn't healthy. Vaporizers don't release some of the same toxic chemicals that combustible tobacco products do, but vaping over the long-term has been linked to heart conditions, mental health issues, and lung disease — though the research on vaping and health is still in its infancy.

The new study, which also includes interviews with five vape influencers and eight Berkeley-area teenagers, suggests the idea that vaping isn't dangerous is still more prominent on social media than the idea that it is dangerous.

They also found that the FDA's vaping campaign was often received negatively by the participants in the focus groups compared to other vaping-related Instagram posts. As one teenager interviewed in the study put it:

"I do not think this message [The FDA's campaign] is effective. It is a super fancy way of reminding us that nicotine is addictive. I imagine myself scrolling on my phone, trying to enjoy myself and [The FDA anti-vaping campaign] is trying to tell me what to do."

The metrics on the #TheRealCost Instagram posts reflect the fact that it isn't resonating. The average percentage of users that engage with an Instagram post is between 3 percent and 6 percent, the study says. But posts with the FDA's hashtag have an average engagement rate of .8 percent — well below that average.

Is fear the answer?

Teen cigarette smoking has drastically declined in the past several decades. In 1996, 28.8 percent of 12th graders said that they smoked in the month before they were surveyed. By 2018, only 3.6 percent of teenagers said that they smoked cigarettes. This decline has been partially attributed to a variety of anti-smoking campaigns, some launched by groups like the American Lung Association.

If you take a look at the history of anti-smoking campaigns, their graphic and striking ads come to mind. Some campaigns rebranded Camel's pro-smoking cartoon camel character "Joe Camel" to "Joe Chemo." More recently, the CDC launched a hard-hitting campaign, "Tips from a former smoker," featuring the experiences of smokers who had lived through some of the habit's worst consequences. One ad reads: "be careful not to cut your stoma."

After that campaign, a Lancet study reported that attempts to quit smoking rose by 12 percent.

So are teens just not scared enough of vaping? And are scare tactics the best way to change vaping's image?

"[We can change vaping's social media image] by posting more anti-vaping intervention content and doing it more frequently focusing on content that not only induces fear of vaping, but also includes other creative youth- participatory campaigns that could be appealing to youth," Vassey says.

But fear isn't the only way that the image of vaping on social media can be changed, she says. In fact, the emphasis on fear in the FDA's anti-vaping campaign was one of the major criticisms revealed by the teens in the focus groups. Some said the FDA's message was fear-mongering "propaganda", and criticized the agency for not providing information on how teenagers can quit vaping.

And therein lies a problem. Resources to help teens quit vaping are still in development, Stanton Glanz, a professor at the University of San Francisco's Center Tobacco Control Research and Education told Inverse previously.

“People have been trying to use the same techniques, but right now, especially for kids, that’s an area of active research. Nobody knows the answer to that right now,” he said.

As the science on the long-term health effects of vaping continues to develop, translating that science into a successful social-media campaign may prove challenging. Meanwhile, scientists and regulators are left struggling to catch up.

Abstract: E-cigarette use is increasing dramatically among adolescents as social media marketing portrays “vaping” products as healthier alternatives to conventional cigarettes. In September 2018, the Food and Drug Administration (FDA) launched an anti-vaping campaign, in U.S. high schools, on social media and other platforms, emphasizing “The Real Cost” of e-cigarettes. Using a novel deep learning approach, we assessed changes in vaping-related content on Instagram from 2017 to 2019 and drew an inference about the initial impact of the FDA's Real Cost campaign on Instagram. We collected 245,894 Instagram posts that used vaping-related hashtags (e.g., #vape, #ejuice) in four samples from 2017 to 2019. We compared the “like” count from these posts before and after the FDA campaign. We used deep learning image classification to analyze 49,655 Instagram image posts, separating images of men, women, and vaping devices. We also conducted text analysis and topic modeling to detect the common words and themes in the posted captions. Since September 2018, the FDA-sponsored hashtag #TheRealCost has been used about 50 times per month on Instagram, whereas vaping-related hashtags we tracked were used up to 10,000 times more often. Comparing the pre-intervention (2017, 2018) and post-intervention (2019) samples of vaping-related Instagram posts, we found a three-fold increase in the median “like” count (10 vs. 28) and a 6-fold increase in the proportion of posts with more than 100 likes (2 vs. 15%). Over 70% of Instagram vaping images featured e-juices and devices, with a growing number of images depicting a “pod,” the type of discrete vaping device that delivers high concentration of nicotine and is favored by novice e-cigarette users. In addition, the Instagram analytics data shared by the vaping influencers we interviewed showed underage Instagram users among their followers.