About 37 million children ages 13 to 15 around the world use tobacco, according to a 2024 report from the World Health Organization.

In 2023, e-cigarettes were the most commonly used tobacco product in the U.S., with 7.7% of middle school and high school students reporting e-cigarette use. Cigarettes were the next most common, with 1.6% of middle- and high school students saying they had consumed them in the past month.

Research shows that most people who use tobacco start in childhood.

I am a public health researcher who studies the different ways in which corporations influence adolescent health, with current projects focused on identifying sources of exposure to tobacco marketing among adolescents and young adults.

Over the past decade, I’ve researched ways in which tobacco companies market to children and young adults.

Health harms of tobacco

Smoking is harmful to every organ in the human body and is known to cause many types of cancers and heart disease, among other problems. Nicotine, by itself, in products like e-cigarettes and oral pouches, is harmful to adolescent brain development.

The adolescent brain develops into early adulthood, especially in the prefrontal cortex. This part of the brain is involved in higher cognitive development, including functions pertaining to attention, memory and cognitive flexibility. Research has shown that nicotine exposure results in long-term functional and structural changes in the brain.

Old tactics in new US products

Decades of research have documented how tobacco companies marketed tobacco products for years to attract young customers in order to sustain and grow their businesses.

In a 2021 study, my team and I showed that exposure to e-cigarette marketing with cartoon images decreased high school students’ perceptions of harm from e-cigarettes. Research makes clear that this change in perspective can make adolescents more open to trying e-cigarettes.

In an earlier study, my team and I examined the impact of e-cigarette product placement and imagery in music videos on propensity to use e-cigarettes among young adults. We found that exposure to e-cigarette product placement in music videos increased young adults’ intentions to try e-cigarettes in the future.

Striking at an early age

While our research has largely focused on the U.S. context, several recent studies have shown how tobacco companies continue to market to children in other parts of the world.

For example, a team of researchers conducted focus groups among Chinese adolescents to understand sources of tobacco marketing exposure and what features made ads attractive. They found that adolescents reported being exposed to tobacco ad campaigns near their home and school. These young Chinese people also reported that bright colors, product packaging and price promotions featured in e-cigarette ads and other promotional materials attracted their attention.

In England, a 2022 study provided an overview of marketing claims present on the websites of popular e-cigarette brands. Most notably, the study found that U.K websites featured medicinal claims for smoking cessation, associations with youth culture and depictions of young people using e-cigarettes.

Normalizing tobacco use

The emergence of social media platforms has led tobacco companies to shift their marketing tactics from traditional channels like magazines, billboards and retail stores to online channels, capitalizing on the time that young people spend on screens.

Tobacco companies have helped normalize tobacco use online with the help of branded social media account pages and social media influencers. For example, in 2021, researchers discovered that e-cigarettes were being used and promoted by influencers on Amazon-owned Twitch, a video-sharing platform popular among adolescent gamers.

Similarly, streaming platforms normalize tobacco use. For example, in a 2022 study, my team and I analyzed Netflix original TV shows and films for e-cigarette-related content. Most notably, we documented brief representations of teenagers holding e-cigarettes in the PG-13 film “Hubie Halloween.” Our findings contradict Netflix’s no e-cigarette pledge for PG-13 content.

This suggests a need for further outside-party monitoring of e-cigarettes in Netflix programming.

Spreading awareness

Every country will have to effectively enforce and expand restrictions on cigarette and e-cigarette marketing to protect children and teenagers from messages that encourage them to try smoking and vaping. Additional efforts are needed everywhere to help discourage young people from getting hooked on tobacco.

Most parents, teachers and other authority figures are likely unaware of the extent to which young people are exposed to tobacco content online, including tobacco ads and peer-generated posts on social media that normalize tobacco use.

Campaigns focused on tobacco-related digital media literacy could create awareness about tobacco products and describe how they are being marketed in the digital environment. There are various evidence-based resources that could be built upon to help young people evaluate tobacco advertising messages, empowering digital and social media users to actively evaluate information rather than remain a passive target for the industry’s marketing.

I am certain that increased awareness could prevent young people from consuming tobacco.

Jon-Patrick Allem receives funding from the California Tobacco Control Program, and the National Institutes of Health. He has received fees for consulting services in court cases pertaining to the content on social media platforms.