The mediating role of relative harm perception in the association between social media marketing exposure-engagement patterns and e-cigarette use behaviors: A cross-sectional study

초록

INTRODUCTION Social media marketing is a key driver of e-cigarette use. While active engagement facilitates message internalization, research on how specific engagement types influence behaviors via relative harm perception remains limited. This study investigates the mediating role of relative harm perception in the relationship between social media marketing engagement and e-cigarette curiosity, current use, and quit attempts. METHODS Data from a cross-sectional web-based survey of 3400 adults aged 19- 69 years in the Republic of Korea were analyzed. Participants were recruited in February 2025 from an opt-in online panel using quota-controlled, nonprobability sampling designed to balance sex and tobacco-use strata. Respondents were categorized into five groups based on the combination of marketing exposure frequency (high vs low) and behavioral engagement (active vs passive), including a no-exposure group. Weighted multivariable logistic regression and mediation analyses were conducted using a regression-based approach with the survey package in R. RESULTS Active engagement was significantly associated with lower relative harm perception and increased e-cigarette use. In the 'Low frequency-active engagement' group, harm perception fully mediated the relationship between engagement and use. Conversely, the 'High frequency-active engagement' group demonstrated strong direct effects on use (adjusted odds ratio, AOR=7.23; 95% CI: 2.99-17.48) and curiosity (AOR=5.07; 95% CI: 1.80-14.27), bypassing mediation. In contrast, the 'High frequency-passive engagement' group exhibited an inverse CONCLUSIONS Active engagement with e-cigarette-related marketing content on social media was associated with lower perceived relative harm and higher odds of e-cigarette curiosity and current use, whereas frequent passive exposure was associated with higher perceived harm and lower curiosity among non-users. These findings underscore the potential importance of incorporating engagement-based metrics when monitoring digital marketing exposure and when evaluating regulatory approaches.

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