Exploring relationships between social media use, online exposure to drug-related content, and youth substance use in real time: a pilot ecological momentary assessment study in a clinical sample of adolescents and young adults.

Introduction: Rising rates of adolescent overdose deaths attributed to counterfeit prescription drugs purchased using social media have drawn national attention to how these platforms might influence substance use. Research suggests a significant relationship exists between exposure to substance-related social media content and use of drugs and alcohol, but most studies are cross-sectional and limited by recall bias. This study used an ecological momentary assessment (EMA) protocol to collect longitudinal data on social media use and online drug-related exposures associated with youth substance use. Methods: Participants, aged 12-23, receiving mental health treatment from a U.S. community-based hospital, joined a six-week, smartphone-based EMA protocol. Each day, participants completed a modified CRAFFT screen for daily substance use and a survey on substance-related online content exposure, and input data from their smartphone screen time reports. Analyses employed mixed effects logistic regression models to explore relationships between substance-related online exposures, substance and social media use. Results: Data was obtained from 25 youth, predominantly white non-Hispanic/Latinx (56.0%) and female (64.0%). Participants had significantly higher odds of substance use on days when exposed to substance-related digital content posted by peers (OR: 19.6). They were also more likely to report these exposures (OR: 7.7) and use substances (OR: 29.6) on days when Snapchat was one of their most frequently used smartphone applications. Discussion: Our results support existing concerns about specific social media platforms being potential mediators of youth substance use. Future EMA studies in larger cohorts should explore the role of social media platforms in substance procurement.