Behind the Smoke Screen: Influences on Tobacco and Nicotine Information-Seeking Via Social Media Among U.S. Young Adults

Abstract

Despite young adults' reliance on social media for health information and the tobacco industry's aggressive marketing on those same platforms, no research has examined how specific platform features shape tobacco-related health information-seeking behaviors (HISB) among this population. This is a gap that stands in contrast to established digital HISB literature on topics such as mental health and chronic disease. Focusing on the features associated with HISB rather than platforms offers a more sustainable foundation for health communication, given how rapidly platforms evolve. This dissertation addresses that gap using an explanatory sequential mixed-methods design with 308 survey respondents aged 18-24 and 18 semi-structured interviews. Discussion forums and AI-powered search significantly predicted HISB engagement; anonymity significantly moderated engagement among Black and multiracial participants. Qualitatively, anonymity emerged as a prerequisite for engagement among POC and LGBTQ+ participants, relatability consistently outweighed accuracy in content evaluation, and TikTok's censorship of tobacco-related search terms functioned as a structural barrier to information access. These findings suggest that for communities most targeted by the tobacco industry, how people access evidence-based cessation information in digital spaces is as much an equity issue as whether that information exists at all. These findings have direct implications for health communication practice. Rather than building institutional campaigns around specific platforms, practitioners should embed evidence-based prevention and cessation content within the anonymous, peer-led digital spaces young adults already inhabit and leverage the same features and spaces the tobacco industry has strategically exploited. In an era when the industry continues to innovate its social media marketing through influencer campaigns, algorithmic curation, and identity-targeted advertising, the public health community must be equally sophisticated and adaptive in its counter-efforts.