Assessing the effects of social media based anti-tobacco campaigns on tobacco use among youth in Virginia: an agent-based simulation approach.

Anti-tobacco campaigns contributed to the great decline of adolescent cigarette smoking in the United States from 2000 to 2022. However, studies on the ways in which campaigns are designed and disseminated on social media to generate optimal impact are limited. We aim to examine the effect of various campaign designs implemented under different structures of social-network influencers on reducing tobacco use among youth in Virginia. An agent-based model (ABM) was deployed from bottom-up to project the influence of anti-tobacco media campaign intervention and social media influencers on students' smoking decisions. High school students in ninth grade reporting never smoking were followed for 48 months through 12th grade. Simulation models assessed student smoking behaviors, accounting for potential interactions with assigned micro/macro factors, social-network structures, and interventions. We found that an anti-tobacco campaign is more likely to reduce smoking intensity than prevalence. A 10% increase in the state-wide campaign reach was associated with 1.31 fewer cigarettes consumed monthly [95% confidence interval (CI): 1.06-1.56], with the effects more substantial in the central and southwest regions of Virginia. For campaigns utilizing five social-media influencers per 1000 youth, a 10% increase in reach was associated with 2.60 fewer cigarettes consumed monthly (95% CI: 2.34-2.87), where the effect of the campaign reach was maximized at 15.13%. Our pioneer study suggests that engaging social media influencers in anti-tobacco social media campaigns is one potentially effective strategy for tobacco use control and prevention. Future research is needed to validate findings in other samples.