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E-cigarette use and promotion by social media influencers during videogame play on Twitch
  1. Julia Vassey,
  2. Jon-Patrick Allem,
  3. Joshua Barker,
  4. Tess Boley Cruz,
  5. Raina Pang,
  6. Jennifer B Unger,
  7. Heather Lynn Wipfli,
  8. Matthew Kirkpatrick
  1. Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
  1. Correspondence to Dr Julia Vassey, Department of Population and Public Health Sciences, Keck School of Medicine University of Southern California, Los Angeles, CA 90032, USA; vassey{at}

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E-cigarette consumption among adolescents around the world, including the USA, is a public health concern.1–3 Exposure to social influencer content and other promotional strategies has been associated with increased risk of e-cigarette use among adolescents and young adults.4–7 One factor contributing to the uptake of e-cigarette use among adolescents is the industry’s overt and covert promotional strategies, including the use of influencers, that target teenagers. Influencers (eg, public figures, promoters, models, bloggers, brand ambassadors with followers of 1000 users or more)8–10 promote e-cigarette products11–13 on behalf of tobacco brands for monetary compensation or other rewards14–17 on social media platforms that are popular among youth (eg, Instagram, YouTube, TikTok, Twitch).13 18–25

We recently discovered evidence of use and promotion of e-cigarettes by influencers on Amazon-owned Twitch, a video-sharing platform, which is similar to YouTube, but caters more to live streamers as opposed to creators of stored, long-lasting content.26 Twitch is predominantly a video gaming platform, where audiences watch or play simultaneous sessions and interact via chat with game streamers (see figure 1 for a typical interface layout).25 27 Twitch draws in 15 million daily active users who engage with the platform’s content and interact (eg, like, comment, talk via live audio) with fellow users and streamers. Overall, Twitch has around 140 million unique monthly average users, nearly 7% of YouTube’s monthly average users, and 9 million active streamers.28 The majority of Twitch users are adolescents and young adults between 16 and 24 years old (predominantly male),28 with the largest percentage of users located in the USA.29 According to Twitch’s own statistics, 21% of its audience are 13–17 years old.30 Twitch, until now, has received little attention from the tobacco control community. This is particularly concerning as Twitch e-cigarette control policies are non-restrictive—that is, e-cigarette use and promotion are officially permitted as long as this activity is legal in the jurisdiction (eg, a state or a country)31 of the streamer/user and/or in compliance with the Federal Trade Commission requirements for endorsements in advertising and promotional materials.32

Figure 1

Computer screenshot of a live gaming session on Twitch (box A: e-cigarette influencer/Twitch streamer consuming e-cigarettes; box B: interactive chat box; box C: representative example of an audience reaction via chat in response to e-cigarette consumption by the streamer). Image of game: Copyright: EPIC games, Inc.

We identified e-cigarette influencers on Instagram who posted promotional images and videos over January–December 2020 and also cross-promoted their content on Twitch, that is, encouraged their Instagram audience to visit their Twitch account for additional e-cigarette-related promotional content. For example, we found several influencers (figures 1 and 2) who vape on camera and/or offer promotional giveaways of e-cigarettes—eg, free samples or discount codes provided to the audience. We also observed several instances of users’ reactions to influencers’ e-cigarette consumption and promotion during streaming sessions, including: (1) questions about the type of promoted flavour; (2) requests for the streamer to perform a vaping-related stunt (eg, to consume multiple pod devices at once (figure 1, ‘C’); and (3) questions about the potential health risks of vaping (eg, probability of getting the serious lung disease bronchiolitis obliterans (‘popcorn lung’)). These live interactive discussions about e-cigarettes in multiple simultaneous forums during gaming sessions are concerning as they could reinforce vaping among youth.

Figure 2

Computer screenshot of live gaming sessions on Twitch where streamers promote and use e-cigarettes (panel A: a promotion of Rare Bar, a disposable e-cigarette device, panel B: e-cigarette use on air). Image of game Copyright: Battle State Games.

Overall, these observations suggest that e-cigarette promotional content on Twitch may be of interest to tobacco control researchers and policy makers. Twitch has many opportunities to expose viewers below the tobacco purchasing age to promotional material. Future research should determine the impact of e-cigarette-related content on Twitch on attitudes and behaviours among young people. Future research should also include systematic identification of specific brands promoted on this platform. Twitch should be encouraged by stakeholders (eg, public health departments, Parents Against Vaping e-cigarettes or PAVe)33 to update its policy regarding e-cigarette marketing to protect underage youth from exposure to overt and covert e-cigarette promotions.

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  • Contributors JV and MK conceived the paper and wrote the first draft of the manuscript. All co-authors provided feedback on the first draft and substantial writing to the final version of the paper. All co-authors approved the final version.

  • Funding Research reported in this publication was supported by the National Cancer Institute and the Food and Drug Administration Center for Tobacco Products (CTP)(U54CA180905). The funders had no role in study design; collection, analysis, and interpretation of data; writing the report; and the decision to submit the report for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.