We collected and analyzed all posts on Instagram (@vusevaporus) and Facebook (Vuse Vapor US), from October 10, 2019, when RJRV submitted its PMTA application to the FDA, to February 21, 2022, about 4 months after the FDA issued the MGO for Vuse Solo (October 12, 2021) allowing us to collect data spanning over winter holidays as that is when companies often do a larger marketing push.

Instagram and Facebook were chosen as the social media platforms from which to collect the data because these were two major platforms where RJRV, the manufacturer who obtained marketing authorization for Vuse products, has actively posted marketing content and their official accounts can be easily identified and distinguished from posts by the general public.

We took screenshots of every post we collected in case some posts were later deleted or edited. A total of 627 posts were collected and coded. As the company often cross-posts contents on Facebook and Instagram, we included 439 unique posts for our final analysis.

Our codebook was adapted from previous studies drawing on the Content Appealing to Youth (CAY) index on youth-appealing features of alcohol and e-cigarette advertisements [20,22,29]. The CAY index contains a wide variety of content characteristics that were specifically designed to attract young audiences. It has a few large categories that incorporate production techniques (a variety of audio-visual effects of the advertising media), character appeal (such as the presence of younger models, animated characters, and influencers), youth-oriented genres (such as humor, magic, or fantasy), situations and activities that are particularly attractive to youth (such as parties, social gathering, and concerts), product features (such as bright colors, sleek designs, flavors, and technology-like appearance), and rewarding appeals (products associated with being successful, rebellious, or gaining status) [30]. Our codebook drew on the existing codebook to identify overall characteristics of the Vuse products, in which youth-appealing features informed by literature may be found [29]. We developed the codebook iteratively as the two coders coded together, while deliberating on the features to be captured and the codes to use. We identified the race and ethnicity of people who were present in the posts through investigator observation.

A total of 159 codes were developed to analyze the posts, which were then combined into 17 themes. The codes represent characteristics of each post, with each post potentially having multiple codes. The following categories and individual codes in our codebook were expected to have potentially youth-appealing features: (1) flavors [31,32], (2) presence of human (perceived younger [22]), (3) promotional incentives (price reduction [33,34] or sweepstakes [35]), (4) product or use cues (having placed together with technological devices or customized design of packaging or wraps [22]), (5) activities (sports, dancing, partying, art, or music [23,24]), (6) setting (great outdoors [35]), (7) imageries (flora or fruit [35,36]), (8) environmental and social justice [35], and (9) rewarding appeals (positive sensation and mood promotion [37], and individuality or freedom [29]).

The full list of themes, definitions, codes, and examples can be found in Table 1. Codes that were expected to have potentially youth-appealing features are noted in italics.

Most of the codes were binary (0 as not present and 1 as present), with a few exceptions for nonbinary options (for example, for perceived race or ethnicity of humans in the advertisement, 1=White, 2=non-White, 3=both White and non-White), or when free text entry was appropriate.

We had two coders (EH and FV) for this study, with agreement on the codes by both coders. Once the 627 posts were collected, we randomly selected 25% (n=157) of the advertisements for coding by both coders, to finalize the codes and establish reliability.

We reached a mean percentage of agreement as 96.2%, after which we deliberated on our disagreements, and independently coded the remaining 75% (n=470) of the posts. The average Krippendorff α is .95) [38,39], with individual codes ranging from 0.67 to 1. We only included unique posts (N=439) for the final analysis.

After coding was complete, we calculated the percentage of the posts for each code.

This study does not involve human participants and instead is just a content analysis of existing social media marketing advertisements. This study is based on publicly available social media posts from official accounts of an e-cigarette company. Only the posts themselves were analyzed. The comments made by users were not analyzed, and when they were shown, were deidentified, so as not to reveal identities. Therefore, ethics board approval was not sought.

Table 2 shows the percentage of the presence of each of our themes, which are further explained next.

We examined social media marketing posts for all products in the Vuse product family, including those that have been authorized (eg, Vuse Solo “original”) and those that have not obtained MGOs (eg, Vuse Alto Menthol). We found that 41.5% (182/439) of posts referred generally to “Vuse” without specifying a particular Vuse product (eg, Solo, Alto, Ciro, and Vibe), and 59.5% (261/439) specifically featured Vuse Alto. One post (0.2% of posts analyzed) featured Vuse Vibe together with Vuse Alto. There were no posts featuring Vuse Solo. Therefore, our findings focus on the marketing and posts for Vuse Alto if not otherwise specified, and on the Vuse Solo MGO when marketing authorization was mentioned.

A total of 9.1% (40/439) of the posts mentioned colors of the device, either a theme color or a variety of colors for choice.

A total of 32.8% (n=144) of the 439 posts mentioned flavors, including 14.4% (n=63) mentioning flavors in general, 7.7% (n=34) mentioning menthol, and 5 mentions of other flavors (eg, “mixed berry,” 1.1%).

A total of 14.6% (64/439) of the posts contained humans (either parts of the human body or full bodies). For those advertisements featuring humans, the majority had people who appeared to be older than 25 years.

A total of 60.4% (265/439) of the posts used promotions. The most common promotion method was cosponsoring an event, including car racing, concerts, and arts (99/439, 22.6%).

Of the 439 posts, a total of 41.7% (n=183) had the power units of the device presented. The power unit is the body of the device and can have different colors that were also highlighted in the posts. The presence of power units helped us identify the products being featured in the posts. A total of 19.4% (85) of the posts showed customized or specially designed wraps of the power unit. Other notable product or use cues included the presence of pods (n=53, 12.1%), product being in use (n=33, 7.5%), and product placed with other consumer products (eg, coffee: n=14, 3.2%), alcohol (n=10, 2.3%), discrete or disguised use (n=8, 1.8%), and technological devices (n=6, 1.4%).

Of the 439 advertisements, 21.6% (n=95) used advertisement-level descriptors. Overall, only a small number of descriptors were used. The most frequently used descriptor was the product being “new” (n=64, 14.6%). Other than that, only a few descriptors were present, with relatively low percentage overall, such as being “fresh” (n=27, 6.2%) and “rich” (n=14, 3.2%). A few posts also featured the product being “green” (n=5, 1.1%).

A total of 9.8% (n=43) of the 439 posts had claims. The most common claim was about savings (n=25, 5.7%) and the quality of e-liquids (n=11, 2.5%). Another noticeable claim was the product being “unique” (n=7, 1.6%). There were no indications of health-related effects or mentions of FDA authorization in any post.

The most common activity depicted was art (150/439, 34.2%), sports or athletics (mostly car racing: 125/439, 28.5%), and music (77/439, 17.5%). Other noticeable activities featured included drinking alcohol (16/439, 3.6%) and vacationing (10/439, 2.3%).

The most common setting of the 439 advertisements was sporting event (n=73, 16.6%), followed by city (n=46, 10.5%).

A total of 19.6% of the posts used identifiable imageries. Flora was the most commonly used imagery (n=49, 11.2%). Other noticeable imageries that were present included alcohol (n=10, 2.3%) and water (n=10, 2.3%).

Most (435/439, 99%) of the advertisements had warnings and disclaimers about nicotine content and age restrictions for purchasing the product.

A total of 3.2% (14/439) of the posts featured environmental and social justice. We have seen posts talking about Vuse as a carbon-neutral product, its commitment to sustainability, and to helping veterans.

The most common rewarding appeal depicted in the 439 posts was creativity or innovation (n=189, 43.1%), followed by individuality or freedom (n=106, 24.2%).

Vuse Solo was the first e-cigarette product to obtain FDA marketing authorization, and “Vuse”-branded advertisements posted on social media provide a first glimpse of how social media marketing may be used for e-cigarette products that have received FDA MGOs. We found that while Vuse Solo received the FDA’s marketing authorization, it never appeared on the official Instagram and Facebook accounts, the only two active official accounts of RJRV, during the period of our study. Instead, Vuse Alto, which was not yet authorized by the FDA during the 28 months of data collection and analysis, was consistently identified in posts on both Facebook and Instagram accounts, and was the only product marketed on those platforms. Importantly, the products marketed on these two platforms were referred to generally as “Vuse,” rather than specifying “Solo” or “Alto.” The most commonly featured themes included creativity or innovation, art, sports or athletics, and individuality or freedom [20]. Vuse also sponsored car racing and art events frequently during the period of study. These contents have been used by tobacco companies for a long time [23,24,40,41], and according to CAY index, they are appealing to youth [20,30]. Other themes that are potentially appealing to youth, including the copresence of alcohol and technological devices [20,42,43], and the featuring of nature themes, were also found.

Our analysis was based on two platforms where the products have been marketed. The posts were collected from the official account of the company (RJRV) that sells these products, and did not include other unofficial channels that are possibly marketing these products with possible youth-appealing strategies that we did not identify in this study [44]. Instagram has age restrictions on contents posted by RJRV that limited the access of users aged younger than 25 years. While users are able to circumvent such restrictions, the likelihood of the contents reaching underaged users may be lower than those user-generated contents without age restrictions. The analysis only focused on the contents of the posts marketing the products but cannot assess users’ perceptions of the contents. Future research could examine more user-generated content related to Vuse products.

Our analysis of the Vuse social media marketing posts indicate a number of potentially youth appealing images and themes, as defined by the CAY index, the existing literature on youth-appealing advertisements [30,45,46], and as described by the FDA [47].

First, the most common social media marketing themes included art and music, featuring creativity and self-expression, all of which are considered youth-appealing by the CAY index [20]. Music [24], art, and design [23] have traditionally been used by major tobacco companies to promote cigarettes to young adults and “hipsters,” hoping that this marketing would spread the trend to a wider variety of younger users [23]. Similarly, RJRV featured sponsored events such as rooftop concerts and music festivals, activities that are youth oriented and likely to reach young consumers and influence use and are among the content that RJRV said in its PMTA that it would not use in its marketing to reduce youth appeal [7]. In addition to art and music, Vuse promotional posts featured themes of creativity and innovation and self-expression (customizing the devices with different designs of wraps, using the devices wherever one feels good), which are all recognized to be youth-appealing features in e-cigarette marketing [18,20].

Second, RJRV’s social media promotional activities for Vuse also included sponsorship of car racing games and featured artists and designers working to design race cars. The MGO said RJRV could mitigate risks to youth by not using marketing content that featured this kind of sports activity [7]. Tobacco companies have historically been major sponsors of car racing [48], and recent surveys showed that car racing events gained more viewership of younger audiences including adolescents [49,50]. In our findings, Vuse-sponsored car racing posts emphasize creativity through featuring collaboration with artists and designers and audience-engaging activities such as submitting their own design work to win prizes, which have the potential to attract creative-minded youth.

Third, while a smaller percentage, we observed posts featuring alcohol with Vuse, and placing technological products such as smartphones with Vuse devices. Couse of alcohol and tobacco products, including e-cigarettes, is associated with concerning health impacts [51,52], and the trend of concurrent or subsequent use of cigarettes or e-cigarettes and alcohol use among adolescents and young adults is disturbing [43,53]. The placement of Vuse with digital or technical products is a tactic frequently used by tobacco companies to target adolescents by promoting e-cigarette devices as cool technology with sleek designs and technology-like appearance [54-56]. Youth are attracted to e-cigarettes designed to be sleek in shape that can be used discreetly [57]. Indeed, JUUL was marketed as the “iPhone of e-cigarettes” and its meteoric rise in popularity was connected to this sleek design [42].

Our findings also showed the presence of nature-related themes, such as flora and water imageries, associating the product with environmental friendliness and a healthy lifestyle [58]. The “environmental and social justice” themes, often featuring the company’s commitment to sustainability and eco-friendliness, were also seen, consistent with other tobacco companies’ campaigns using environmental themes to greenwash their products [59], which could be of particular interests to youth, and companies are using greenwash for this purpose [60].

Instagram and Facebook purportedly restrict the marketing content for tobacco products by only allowing companies to post and sell tobacco products to age-restricted audiences [61]. However, social media platforms are generally self-regulated, and age restrictions vary across platforms. It is highly possible for users to bypass age gating and be exposed to age-restricted marketing contents.

To continue marketing a new tobacco product, the company must demonstrate that the marketing would be “appropriate for the protection of the public health” meaning that the benefits to current tobacco product users who might stop using the products outweighs the harms to youth and other nonusers who might start using the products [62]. A significant factor supporting the FDA’s determination that Vuse Solo met the APPH standard was that while current established cigarette users who might use Vuse Solo to switch would prefer the original or tobacco flavor, “existing evidence consistently indicates that use of tobacco-flavored ENDS is less common compared to non-tobacco flavored ENDS among youth.” [63] However, recent studies presented insufficient evidence of any public health benefits associated with Vuse Solo to either adults or youth [64,65]. After data collection and completion of this study, the FDA authorized the marketing of Vuse Alto tobacco-flavored pods and devices [15]. Nevertheless, the findings clearly showed that RJ Reynolds marketed the more popular unauthorized product (Vuse Alto) and that regardless of authorization, products being marketed continue to use advertisements with features that are appealing to youth. Further, given Vuse Alto’s largest market share among all Vuse products and the second largest market share of e-cigarette sales in the United States, and the popularity among high school students [1,66], there is great concern about the marketing of these products and whether the APPH standard is being met.

Our analysis demonstrates that Vuse Alto social media marketing is likely targeting and appealing to adolescents, and therefore likely to promote use by minors. The FDA stated it intends to prioritize enforcement against unauthorized e-cigarettes such as Vuse Alto that are “targeted to minors or whose marketing is likely to promote use” by minors [11]. Based on our findings and the FDA’s stated priorities, the FDA should enforce against the marketing of Vuse Alto e-cigarette products which is appealing to and likely promoting use by minors. In future MGOs, the FDA should explicitly state that the authorized products of the subject MGO must not be comarketed, explicitly or implicitly, with unauthorized products, especially on media channels that would increase exposure to adolescents, including social media.

Social media posts for unauthorized Vuse products use themes that are appealing to adolescents and are likely to promote youth use, including creativity and innovation, self-expression, arts and music, nature, technology, and alcohol imagery. The findings are important for the authorization of all e-cigarettes. Marketing of brands that are and are not authorized by the FDA is likely indistinguishable to users and potential users, especially youth. As such, it is not APPH to allow comarketing or marketing of brands that are not authorized by the FDA, and it violates the conditions underlying the Vuse Solo MGOs, thus potentially providing the FDA sufficient grounds to issue an order withdrawing the MGOs. The FDA should abide by its own enforcement priorities and enforce against marketing of unauthorized products whose marketing is likely appealing to adolescents and promote youth use. The results of this study suggest that stronger enforcement is generally needed against thousands of other unauthorized products that are currently marketed to youth. Finally, the FDA should prohibit companies from explicitly or implicitly comarketing unauthorized products alongside authorized products.