LAUSR

INTRODUCTION Engagement with online tobacco marketing among US adolescents increased from nearly 9% (2013–2014) to 21% (2014–2015). Such engagement increases the risk of tobacco use initiation. Despite the increase in the prevalence of and risks associated with engagement, the reasons why adolescents and young adults engage are not known. METHODS A sample of 2619 adolescents (13–17 years) and 2625 young adults (18–24 years) living in the US participated in an online survey in July–August 2017. Engagement with online tobacco marketing was assessed through five forms of engagement (e.g. watched a video online promoting tobacco products). Reasons for engagement were assessed through an open-ended survey question. Prevalence of reasons for engagement was calculated overall, by tobacco use status, and by age group (adolescents and young adults). Multivariable logistic regression models were fit with engagement as the outcome (overall and specific reasons) and sociodemographics (including age, gender, and race/ethnicity) and tobacco use status (non-susceptible and susceptible never tobacco users; ever, but not past 30-day tobacco users; and past 30-day tobacco users) as covariates. RESULTS Across all tobacco use statuses, the leading reasons for engagement were curiosity or desire for general knowledge about tobacco products (3.9%); incidental, unintended or forced exposure to tobacco ad (3.8%); and seeking discounts, coupons, incentives, or contests (2.9%). Susceptible never tobacco users were more likely to engage because of curiosity or general knowledge than non-susceptible never tobacco users (adjusted odds ratio, AOR=6.81; p<0.01). Past 30-day tobacco users were more likely to engage because of discounts, coupons, incentives, or contests and product appeal than ever, but not past 30-day tobacco users (AOR=7.10; p<0.01). CONCLUSIONS Stricter state and federal regulation of tobacco marketing, specifically tobacco ads and coupons, and stronger self-regulation by social networking sites could reduce youth engagement with online tobacco marketing.