BACKGROUND:
As adolescent e-cigarette use (vaping) escalates globally1, vaping among adolescents in South Africa has also risen rapidly2. To advance health equity and sustainable tobacco control, it is critical to understand how digital environments influence e-cigarette initiation. This study examines the association between social media engagement and adolescent e-cigarette use.

METHODS:
A survey was conducted among high school students in Pretoria (N=634). Multivariate logistic regression was used to analyze the relationship between current e-cigarette use (past 30 day use) and several independent variables: total daily social media hours (SM-Hours) and specific platform use (Facebook, TikTok, Instagram, Twitter, Snapchat, YouTube). The model was adjusted for age and sex.

RESULTS:
Current e-cigarette use was higher among females than males (24.7% vs. 16.1%; p = 0.013) and was highest among those with Facebook profiles (33.9%). Compared with males, females reported higher SM-Hours (4.1 vs. 4.9; p < 0.001) and a higher frequency of Facebook use. In the final adjusted model, being a female was no longer significantly associated with e-cigarette use but students aged 16 or older had significantly higher odds of use (aOR = 1.70, p = 0.017), and each additional hour spent on social media increased the likelihood of current e-cigarette use by 13% (aOR = 1.13, p = 0.002). Furthermore, students with a Facebook profile were three times more likely to be current e-cigarette users (aOR = 3.37, p < 0.001), whereas engagement with YouTube was a significant protective factor (aOR = 0.28, p < 0.001).

CONCLUSIONS:
This study’s findings suggest that the higher e-cigarette use among high school female students may be mediated through longer hours of social media exposure and greater engagement with Facebook. To ensure an inclusive and sustainable public health response, interventions must target Facebook and address the unique vulnerability of female high school students.