TY  - JOUR
AU  - Wu, Jiaxi
AU  - Origgi, Juan Manuel
AU  - Ranker, Lynsie R
AU  - Bhatnagar, Aruni
AU  - Robertson, Rose Marie
AU  - Xuan, Ziming
AU  - Wijaya, Derry
AU  - Hong, Traci
AU  - Fetterman, Jessica L
PY  - 2023
DA  - 2023/3/14
TI  - Compliance With the US Food and Drug Administration’s Guidelines for Health Warning Labels and Engagement in Little Cigar and Cigarillo Content: Computer Vision Analysis of Instagram Posts
JO  - JMIR Infodemiology
SP  - e41969
VL  - 3
KW  - tobacco
KW  - cigar
KW  - little cigar
KW  - cigarillo
KW  - Instagram
KW  - social media
KW  - influencer promotion
KW  - tobacco advertising
KW  - health warning
KW  - machine learning
KW  - computer vision
KW  - warning label
KW  - health label
KW  - health promotion
KW  - advertising
KW  - advertise
KW  - smoking
KW  - smoker
KW  - algorithm
KW  - visualization
AB  - Background: Health warnings in tobacco advertisements provide health information while also increasing the perceived risks of tobacco use. However, existing federal laws requiring warnings on advertisements for tobacco products do not specify whether the rules apply to social media promotions. Objective: This study aims to examine the current state of influencer promotions of little cigars and cigarillos (LCCs) on Instagram and the use of health warnings in influencer promotions. Methods: Instagram influencers were identified as those who were tagged by any of the 3 leading LCC brand Instagram pages between 2018 and 2021. Posts from identified influencers, which mentioned one of the three brands were considered LCC influencer promotions. A novel Warning Label Multi-Layer Image Identification computer vision algorithm was developed to measure the presence and properties of health warnings in a sample of 889 influencer posts. Negative binomial regressions were performed to examine the associations of health warning properties with post engagement (number of likes and comments). Results: The Warning Label Multi-Layer Image Identification algorithm was 99.3% accurate in detecting the presence of health warnings. Only 8.2% (n=73) of LCC influencer posts included a health warning. Influencer posts that contained health warnings received fewer likes (incidence rate ratio 0.59, P<.001, 95% CI 0.48-0.71) and fewer comments (incidence rate ratio 0.46, P<.001, 95% CI 0.31-0.67). Conclusions: Health warnings are rarely used by influencers tagged by LCC brands’ Instagram accounts. Very few influencer posts met the US Food and Drug Administration’s health warning requirement of size and placement for tobacco advertising. The presence of a health warning was associated with lower social media engagement. Our study provides support for the implementation of comparable health warning requirements to social media tobacco promotions. Using an innovative computer vision approach to detect health warning labels in influencer promotions on social media is a novel strategy for monitoring health warning compliance in social media tobacco promotions. 
SN  - 2564-1891
UR  - https://infodemiology.jmir.org/2023/1/e41969
UR  - https://doi.org/10.2196/41969
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37113379
DO  - 10.2196/41969
ID  - info:doi/10.2196/41969
ER  -