Tobacco product message exposure and use in real-time: An ecological momentary assessment approach

Emily T Hebert, The University of Texas School of Public Health


Background: The nature and extent of tobacco industry online marketing and pro-tobacco social media content is poorly understood. Current methods to measure exposure to tobacco ads or promotions are severely limited, relying on recall, recognition, or proxy measures. The present study used ecological momentary assessment (EMA) to examine exposure to tobacco and e-cigarette related messaging among young adults. The specific aims were: 1) To determine the feasibility and validity of a smartphone application for the measurement of tobacco and e-cigarette message exposure via EMA; 2) To evaluate the relationship between daily-reported exposure to pro-tobacco messages and daily tobacco and e-cigarette use; and 3) To evaluate the relationship between the affective response to pro-tobacco messages and intentions to use tobacco and e-cigarettes. Methods: Participants in this study were 148 young adults aged 18-29 living in Austin, Texas and its surrounding areas. Participants were instructed to record all sightings of marketing or social media related to tobacco or e-cigarettes seen over the course of 4 weeks, using a smartphone application. Tobacco product use and recall of message sightings were evaluated every 24 hours, and participants were asked to submit reports of any messages encountered in real time. To examine the study aims, paper 1 utilized descriptive statistics, zero-order correlations, and paired samples t-tests. Papers 2 and 3 utilized generalized linear mixed models. Results: Paper 1 revealed that a smartphone application was a feasible and acceptable method to measure exposure to pro-tobacco marketing and messages among young adults using EMA. The majority of tobacco and e-cigarette-related messages encountered by young adults were seen on the Internet, and many were user-generated. Daily recall and 30-day recall of messages encountered were reasonably well-correlated, with a stronger correlation for user-generated messages than for industry-sponsored messages. In contrast, the correlations between the actual number of messages reported and the perceived frequency of messages encountered in various locations was extremely poor, with a small but significant correlation only for messages seen in convenience stores. Paper 2 demonstrated that there was a significant relationship between daily exposure to tobacco and e-cigarette messages and use of these products, even controlling for baseline product use. Paper 3 revealed that messages depicting e-cigarettes or hookah were associated with significantly higher positive affective responses compared to traditional cigarettes, and that positive affective response to a message was significantly associated with intentions to use tobacco and e-cigarettes. Discussion: Research examining the nature, extent, and impact of pro-tobacco and e-cigarette messages on the Internet and social media is still in its nascent stages. These findings suggest that EMA is a valuable method for the measurement of tobacco message exposure. This study adds unique, timely, and critically needed information to the extant knowledge base that will inform future research and regulation.

Subject Area

Public health

Recommended Citation

Hebert, Emily T, "Tobacco product message exposure and use in real-time: An ecological momentary assessment approach" (2016). Texas Medical Center Dissertations (via ProQuest). AAI10126236.