Social media-based interventions to prevent adolescent nicotine use: a scoping review.

Despite growing concerns about adolescent nicotine use, the evidence regarding the outcomes of social media-based prevention efforts remains underexplored. This scoping review maps the scope, characteristics, and outcomes of (i) social media-based prevention interventions and (ii) educational interventions addressing adolescents' interpretation of nicotine-related social media content. PubMed, PsycINFO, Scopus, ERIC, and CINAHL were systematically searched in March 2024 and updated in November 2025. Peer-reviewed English-language articles published since 2006 were included; cessation-focused studies were excluded. Of 1626 records screened by two independent reviewers, 18 studies met inclusion criteria. A structured codebook guided data extraction. The 18 included studies encompassed a wide range of designs, including online experiments, longitudinal and cross-sectional studies, content analyses, and qualitative research. Interventions ranged from message testing and simulated social media exposure to large-scale public health campaigns (e.g. "Rethink Vape," "Truth," "The Real Cost," and "Fresh Empire"), alongside one school-based media literacy program ("MediaSense"). Most studies reported short-term improvements in knowledge, risk perception, or engagement, whereas evidence for sustained behavior change or reduced nicotine use was limited. Common limitations included reliance on self-reported outcomes and short follow-up periods. Most studies reported improvements in knowledge and risk perceptions, whereas evidence for sustained behavioral outcomes remains methodologically heterogeneous and largely focused on short-term outcomes. More rigorous longitudinal evaluations and sustained public health investment are needed. For practitioners and policymakers, the findings support investment in culturally tailored, platform-native campaigns alongside stronger regulatory frameworks to limit adolescents' exposure to nicotine-related marketing in digital environments.