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Background: Exposure to visual posts featuring e-cigarette products on social media is associated with increased e-cigarette use among US adolescents. Instagram is the largest source of e-cigarette social media marketing, where influencers-for example, bloggers, brand ambassadors-post promotional materials. This study analysed the network of e-cigarette brands and influencers on Instagram, characterising the most central players in e-cigarette social media marketing., Methods: We tracked influencers with public profiles on Instagram who posted promotional e-cigarette content in 2020, had over 1000 followers and high user engagement rate (ratio of likes and comments to followers) of 1%-25% per post. By conducting a social network analysis, we identified the most central (highly involved in promotional activities) influencers and e-cigarette brands. The number of the influencers' followers aged 13-17 years old and the age verification practices restricting youth access were also assessed., Results: There is a highly interconnected network of engaging e-cigarette influencers (n=55) worldwide who collaborated with over 600 e-cigarette brands in 2020. The Asian and US influencers had five to six times more teenage followers compared with the European influencers. 75% of the influencers did not restrict youth access to their promotional content on Instagram. The brands Voopotech, Innokin, Geekvape, Lost Vape, Smok and Vaporesso collaborated with the largest number of influencers (mean n=20)., Conclusions: It is important to understand associations among influencers and e-cigarette use behaviours, especially youth, to inform effective public health communication and potential policies that could regulate social media marketing sponsored by e-cigarette companies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Exposure to e-cigarette marketing on social media is a risk factor for e-cigarette use among youth. Tobacco brands use influencers to promote e-cigarettes on social media; however, influencer marketing has not been sufficiently studied. This study explored network connections and interactions through comments on social media posts between global nano- and micro-influencers (influencers with approximately 1,000 to 100,000 followers) and their audiences on Instagram and TikTok. We constructed directed unipartite networks among Instagram (N = 104) and TikTok (N = 100) influencers and users on Instagram (N = 55,622) and TikTok (N = 68,673) who commented on these influencers' posts in 2021–2022 (including influencers who commented on each other's posts). Comments to posts of users who were not classified as influencers were not collected. The Instagram network was denser (more interconnected) and more active compared to the TikTok network (1.48 times as high density, 281 times as high transitivity, and 86 times as high reciprocity). Both Instagram and TikTok networks contained heterophilic ties (i.e., influencers from different geographic regions such as Asia, North America and Europe connected to each other), indicating that influencers from different geographic regions engage with (comment on) each other's content, potentially exposing audiences to a wide variety of e-cigarette content. Influencers who promote e-cigarettes and post about lifestyle topics (e.g., fitness, fashion, gaming) occupy more central positions in the Instagram and TikTok networks than influencers who focus primarily on e-cigarette promotion, potentially exposing users who are not interested in tobacco-related content to harmful imagery of e-cigarettes. The findings emphasize the need for strengthening influencer marketing regulation on social media platforms popular among youth. [Display omitted] • The Instagram network is denser than the TitkTok network. • Influencers from different regions engage with each other's content, likely exposing users to diverse e-cigarette content. • Influencers posting about e-cigarettes and lifestyle could expose users uninterested in e-cigarettes to e-cigarette posts. • The study's findings highlight the need for stronger influencer marketing regulations on social media popular among youth. [ABSTRACT FROM AUTHOR]