Major US tobacco brands flouting platform + federal policies to restrict young people’s access to their content on Instagram

Violations include lax/missing age verification, sponsorship disclosure, and health warnings

BMJ Group

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Leading US tobacco brands are flouting platform and federal marketing policies designed to restrict young people’s access to their content on the popular social media platform Instagram, indicates research published online in the journal Tobacco Control.

 

Violations include lax or missing age verification, disclosure on brand-influencer relationships, and health warnings, the findings show.

 

In 2024, around 2.25 million middle and high school students reported having used a tobacco or nicotine product in the past 30 days. That’s nearly 550,000 fewer than in 2023, but still leaves millions of teen nicotine users, underscoring the ongoing need for policy and prevention efforts, emphasise the researchers.

 

Most existing research on tobacco-related social media data has summarised themes, content types, and the prevalence of pro-tobacco messaging, note the researchers. But few studies have assessed compliance with specific federal or platform level marketing policies designed to restrict young people’s access to such content, they add.

 

To plug this knowledge gap, the researchers retrospectively collected 1654 Instagram posts relating to e-cigarettes, cigarettes, and nicotine pouches, and posted between October 2022 and the end of September 2024.

 

These were collected from the main pages and tagged sections of 6 leading tobacco brand accounts, based on market share data and consumer reviews: Vuse; Lost Mary; ZYN; Velo; Lucky Strike; and Winston.

 

The posts were analysed and coded for compliance with Instagram, Federal Trade Commission (FTC), and US Food and Drug Administration (FDA) marketing policies, including age verification, financial disclosure for influencers/celebrities with at least 10,000 followers, presence of required health warnings (‘contains nicotine’, for example), and restricted URL links.

 

To test Instagram’s age-gating policy, one of the researchers created a new Instagram account registered to a fictitious user under the age of 21. Instagram requires users to enter a birth date during account setup, which determines access to age-restricted content.

 

The researcher then systematically clicked on the associated URL link. Posts that were accessible without age verification were recorded as non-compliant.

 

Instagram also prohibits content or posts that directly sell, link to, or facilitate access to branded tobacco products.To evaluate this policy, coders reviewed the account profile

associated with each post and coded it for the presence of URL links to affiliate pages, products, and services. The percentage of posts with account profiles that contained such URL links, indicating non-compliance, was recorded.

 

The analysis revealed major gaps in enforcement. Over two thirds (69.5%;1148) of the posts contained URL links to commercial tobacco websites. Unrestricted access to tobacco content was observed among nearly half (47%; 772) of the posts, which came from 2 brands: Lucky Strike and Lost Mary.

 

“This is particularly concerning given that Lost Mary has been shown to use marketing tactics in their Instagram posts that may be appealing to youth (eg, featuring flavoured products and use of bright colours),” note the researchers.

 

Influencers or celebrities appeared in nearly 1 in 5 (19%; 317) posts, of which nearly 42% (132) didn’t disclose a financial relationship between the brand and the influencer or celebrity. These posts received the highest average number of likes (115).

 

Influencers or celebrities who partnered with Vuse and Velo inconsistently disclosed their financial relationship across multiple posts; and 88% (278) of influencer or celebrity-related posts contained URL links.

 

Nearly three quarters (73%;1200) of posts carried a health warning label, but only just over 41% (683) carried an age warning label. Only a few posts related to unsubstantiated health claims (less than 1%; 15).

 

The researchers acknowledge that the findings relate to data collected during a specific time frame and for 6 brands only. The findings may therefore not apply to subsequent periods of time, other brands, or other social media platforms. Nor were the researchers able to confirm if an actual financial relationship existed between an influencer’s account and a brand.

 

But they point out: “Despite platform-specific policies restricting access to promotional tobacco content and prohibiting direct sales, posts contained links to commercial tobacco websites, suggesting inconsistent enforcement of Instagram’s age-gating and commerce policies.

 

“Federal policies require transparency in advertising, including in influencer-brand partnerships, yet influencer-related posts lacked proper FTC-mandated disclosures of financial relationships.

 

“Additionally, compliance with FDA regulations on health warnings was inconsistent, as a portion of posts failed to contain the required nicotine addiction warnings.”

 

They add: “Taken together, these findings highlight ongoing concerns regarding tobacco posts on Instagram, compliance with existing policies, and the potential impact of these posts on shaping youth pro-tobacco-related attitudes and behaviours.”

 

And they conclude: “These findings underscore the need for tobacco control policies to regulate direct promotions and address the role of marketing tactics that contribute to youth tobacco normalisation.”

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Journal

Tobacco Control

DOI

10.1136/tc-2025-059609 

Method of Research

Observational study

Article Title

Evaluating policy compliance among leading tobacco brands on Instagram

Article Publication Date

27-Jan-2026

 

More than just ‘daydreaming’ – dissociation is the mind’s survival tactic

Taylor & Francis Group

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The word ‘dissociation’ has grown in popularity and become embedded in everyday language, but while the term has gained traction in popular culture and mental health advocacy, misconceptions persist – including some which are harmful, experts say.

Some of the myths – that it happens all the time and is the same as daydreaming or zoning out, or on the other hand, is really rare or fictitious – can be particularly damaging.

Dissociation, explain the editors of Working with Dissociation in Clinical Practice, is far more complex. The editors, Helena Crockford, Melanie Goodwin and Paul Langthorne, describe it as a survival mechanism in response to overwhelming trauma.

“Dissociation is as common as other serious mental health difficulties, yet remains one of the most misunderstood and under-recognised experiences in mental health care,” they explain.

“Dissociation is currently best understood as an adaptive defence to overwhelming trauma. It represents an automatic, reflexive evolutionary response to threat, serving to protect the person by reducing their awareness of intolerable (traumatic) experience.”

We all have the natural ability to dissociate at times, which can allow us to carry on with life and function effectively during heightened emotional stress or trauma, for example, dealing with an emergency calmly in the moment but feeling the shock and emotion later. But for those who experience long-term trauma, the dissociation can become severe and entrenched.

The book, which is published in partnership with the Association of Clinical Psychologist UK, seeks to dismantle these myths and provide clarity on the condition’s profound impact on memory, identity and perception. It features contributions from more than 100 experts in professional practice and research, across various fields including psychology, psychotherapy, psychiatry and mental health services, and those with lived experience of dissociation.

Dissociation is a survival mechanism

Dissociation is not rare, nor is it fictitious. Research confirms its prevalence among individuals who have experienced trauma, particularly early in life.

In fact, research shows between 1.1%-1.5% of the general population will likely have dissociative identity disorder (the most severe form of dissociative experience), with 4.1% likely to present with a dissociative disorder in general (including DID but also other dissociative disorders).

Experts describe dissociation as a mental and physical process that disrupts conscious awareness, impeding the integration of thoughts, feelings and memories.

“Dissociation can involve a wide array of experiences, from mild to severe, from temporary to chronic. However, for people who have experienced overwhelming trauma, often early in life and without a secure attachment to create safeness, more chronic patterns of severe dissociation may develop over time that become entrenched and problematic,” the editors explain.

There is no single ‘dissociation’ or type of dissociation. Instead, the condition can manifest in many ways and can include more commonly known experiences such as feeling detached from your body or that the world around you is unreal. It can also involve less common experiences such as confusion about your identity, sudden shifts in behaviour or identity as if you were a different person, and these shifts can be accompanied by memory loss or amnesia.

Dissociative experiences can be psychological or physical in nature and can result in the person feeling either too much or too little.

These experiences, while protective in the face of trauma, can become chronic and impair daily functioning.

Dispelling myths and addressing stigma

Societal stigma surrounding dissociation is another barrier to understanding, the editors suggest, particularly the myth that the condition is ‘made up’.

Advancements in neuroscience have validated dissociation as a real and measurable phenomenon. Neuroimaging studies reveal distinct patterns of brain activation in individuals with dissociative disorders, providing objective evidence of the condition’s impact. In Dissociative Identity Disorder, for example, very different brain areas are activated depending on the dissociative state the person is experiencing. These differences in brain activation could not be mimicked by actors.

Media portrayals of dissociation, often dramatised and sensationalised, further fuel scepticism and stigma, making it harder for individuals to seek help. The authors emphasise the need for accurate representation and education to counteract harmful stereotypes.

Effective treatment

The experts advocate for dissociation-specific treatment options, particularly in healthcare systems like the UK’s NHS, where such options are often lacking.

Research has shown that untreated dissociation leads to poor physical health, emotional regulation and social functioning. The editors call for increased training and resources for healthcare professionals to recognise and respond to dissociation effectively – saving long-term harm for the individual and being more cost-effective for the healthcare system.

Effective treatments for dissociation, are based on a trauma-phased approach, and a range of adapted psychological therapies, and offer hope for recovery. There is increasing evidence emerging that such treatments are not only clinically effective but also a lot more cost effective than ‘treatment as usual’.

The book’s contributors call for greater awareness, advocacy and compassion for the condition, and challenge people to rethink their understanding of dissociation, and view it as a vital survival strategy.

“Efforts to improve the ability of services to realise, recognise, and respond to trauma-related dissociation will help to benefit not just people who experience trauma-related dissociation but also their families, social networks, and society.”

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DOI

10.4324/9781003625650 

 

Researchers identify genetic blueprint of mania in bipolar disorder

King's College London

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Researchers at King’s College London and the University of Florence have, for the first time, identified the specific genetic blueprint of mania, the defining feature of bipolar disorder.

Bipolar disorder is one of the most severe and complex psychiatric conditions, affecting around 2% of people worldwide. While episodes of depression, psychosis and other symptoms are common, mania is what distinguishes bipolar disorder from other mental illnesses. Mania is a state of persistently elevated or irritable mood marked by increased energy, reduced need for sleep, rapid thoughts and speech, and, in some cases, impaired judgement, impulsive behaviour or psychotic symptoms. Until now, however, the biology of mania has been difficult to study because many people with a diagnosis of bipolar disorder also have episodes of depression and psychosis, making it hard to determine what is specific to bipolar disorder itself.

To uncover the genetic basis of mania, the researchers used data from very large international genetic studies, including more than 27,000 people with severe bipolar disorder and over 576,000 individuals studied for depression. They applied an advanced statistical approach that allowed them to separate the genetic signals for mania from those for depression. In simple terms, this method works by subtracting the genetic effects associated with depression from those seen in bipolar disorder, leaving behind the genetic component that is specific to mania. This made it possible to study mania as its own biological process for the first time.

The study found that mania accounts for more than 80% of the genetic variation in bipolar disorder, underlining its central role in the condition. The researchers identified 71 genetic variants linked specifically to mania, including 18 regions of genes that had never previously been associated with bipolar disorder. Many of these genes are involved in voltage-gated calcium channels, which are essential for communication between brain cells and for regulating mood. When compared genetically with other traits, mania showed a distinct profile, sharing less genetic overlap with substance use and more with measures related to wellbeing and educational attainment than bipolar disorder as a whole.

Understanding the genetics of mania is critically important because it offers a direct window into the core biology of bipolar disorder. Many people with bipolar disorder first seek help during depressive or other types of episodes, when the condition can look very similar to severe depression or schizophrenia. As a result, individuals can spend up to a decade moving between different diagnoses before bipolar disorder is correctly identified. By defining the genetic features that are unique to mania, this research moves the field closer to identifying early biological indicators of bipolar disorder, with the potential to shorten this diagnostic journey  and ensure people receive the right treatment sooner.

Important implications for diagnosis and treatment

These findings have important implications for diagnosis and treatment. Psychiatrists currently distinguish between several forms of bipolar disorder, such as Bipolar type  I, Bipolar type II and cyclothymia, largely based on patterns of mood episodes over time.  A clearer understanding of the biology of mania may help refine these distinctions, identify additional subtypes, and support more personalised approaches to care. The results also highlight potential treatment pathways, including calcium-channel mechanisms, and suggest that established medications such as lithium may exert their effects through these biological systems.

Dr Giuseppe Pierpaolo Merola, MRC Clinical Research Training Fellow, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, lead author of the study, said: “By isolating the genetic architecture of mania, we have taken a crucial step towards understanding the core biology of bipolar disorder. This allows us to see what makes mania distinct, rather than viewing bipolar disorder simply as a mixture of mania, depression and psychosis, and opens new possibilities for more precise and personalised treatments.”

Professor Gerome Breen, Professor of Psychiatric Genetics at King’s College London and Mental Health BioResource Lead at the NIHR Maudsley Biomedical Research Centre, said: “Mania is what defines bipolar disorder, yet it has remained surprisingly difficult to study in its own right. Our research on the genetics of mania gives us a clearer picture of its biology and how it differs from other psychiatric conditions. In the longer term, this could help clinicians recognise bipolar disorder earlier, reduce the long delays many patients face before receiving a diagnosis, and improve outcomes through more targeted treatment.”

The research was conducted at the Institute of Psychiatry, Psychology & Neuroscience at King’s College London in collaboration with the University of Florence. It was funded by the National Institute for Health and Care Research Maudsley Biomedical Research Centre. The study was published on 28 January 2026 in Biological Psychiatry.

 

Notes to editors 

 

Under Embargo until 00.01 GMT Wednesday 28 January 2026

For more information and a copy of the paper under strict embargo, please contact : 

Alex Booth Senior Communications and Engagement Manager, NIHR Maudsley BRC, alex.booth@kcl.ac.uk 

 

About King’s College London and the Institute of Psychiatry, Psychology & Neuroscience  

King’s College London is amongst the top 35 universities in the world and top 10 in Europe (THE World University Rankings 2023), and one of England’s oldest and most prestigious universities.  

With an outstanding reputation for world-class teaching and cutting-edge research, King’s maintained its sixth position for ‘research power’ in the UK (2021 Research Excellence Framework).  

King's has more than 33,000 students (including more than 12,800 postgraduates) from some 150 countries worldwide, and some 8,500 staff. The Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s is a leading centre for mental health and neuroscience research in Europe. It produces more highly cited outputs (top 1% citations) on psychiatry and mental health than any other centre (SciVal 2021), and on this metric has risen from 16th (2014) to 4th (2021) in the world for highly cited neuroscience outputs. In the 2021 Research Excellence Framework (REF), 90% of research at the IoPPN was deemed ‘world leading’ or ‘internationally excellent’ (3* and 4*). World-leading research from the IoPPN has made, and continues to make, an impact on how we understand, prevent and treat mental illness, neurological conditions, and other conditions that affect the brain. 

www.kcl.ac.uk/ioppn | Follow @KingsIoPPN on Twitter, Instagram, Facebook and LinkedIn 

 

The National Institute for Health and Care Research (NIHR) 

The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by: 

• Funding high quality, timely research that benefits the NHS, public health and social care; 

• Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services; 

• Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research; 

• Attracting, training and supporting the best researchers to tackle complex health and social care challenges; 

• Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system; 

• Funding applied global health research and training to meet the needs of the poorest people in low- and middle-income countries. 

NIHR is funded by the Department of Health and Social Care. Its work in low- and middle-income countries is principally funded through UK Aid from the UK government. 

 

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Journal

Biological Psychiatry

DOI

10.1016/j.biopsych.2025.11.008 

Method of Research

Observational study

Subject of Research

Human tissue samples

Article Title

Isolating the genetic component of mania in bipolar disorder

XXI CENTURY MESMERISM

Delivery of magnetic energy to the brain is a cost-effective treatment option for patients with depression, finds a new study

University of Nottingham

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A major new study has found that transcranial magnetic stimulation (TMS), which applies magnetic energy to the brain, can be a cost-effective treatment option for the NHS in treating moderate and severe forms of depression that have not responded to other treatments.

The economic analysis, which is published in BMJ Mental Health, compared TMS to usual care in specialist mental health services, and found that TMS reduces depressive symptoms, eases pressures on informal carers and on NHS resources, and helps people get back to work.

TMS represents an investment in care that recovers its costs over time, primarily from savings to the wider health service and from fewer workdays being lost because of long-term depression.

The study was led by senior health economist Edward Cox from the Nottingham Clinical Trials Unit at the University of Nottingham and Professor Richard Morriss from the Institute of Mental Health, National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, and the NIHR HealthTech Research Centre in Mental Health (MindTech).

Major depression is the leading cause of disability lost years worldwide (WHO, 2017), and suicide from depression is one of the biggest killers of people aged between 15-49. Antidepressants and therapy delivered as first or second-line treatments help two thirds of people with depression, but the remaining third have treatment resistant depression (TRD). This is defined as a lack of response to two courses of antidepressants.

TMS is an outpatient treatment where people have powerful magnetic pulses delivered to the left side of their head just in front of the temporal area of the scalp. The person is conscious and has at least 20 sessions over a four-to-six-week period.

Although TMS is safe and effective as a treatment for TRD and was approved in 2015 by the National Institute for Health and Care Excellence (NICE) for use in the NHS, it remains inaccessible for the majority of patients. Although TMS was invented in the UK, the equipment produced by UK industry, and has been proven effective and implementable within mental health care services, it is only available in one in seven NHS Trusts. One of the main reasons for this is the lack of evidence showing its value for money.

In this new study, experts set out to assess the cost-effectiveness of two forms of TMS, repetitive transcranial magnetic stimulation therapy (rTMS) and intermittent theta-burst stimulation (iTBS), compared to usual care for TRD. The study also seeks to establish the operational circumstances in which TMS could be deemed to represent value-for-money to the NHS and wider society.

Susan Varley, a patient who has received a course of TMS therapy, said: “As a previously high functioning nurse, I suffered severe depression and had to be admitted to hospital because of the severity of my depression. I tried all sorts of different treatments for my depression. Nothing worked. I then travelled to receive a course of TMS and it has transformed my life. I am back working as a nurse, lost four stone in weight and I am enjoying life again with family and friends. I strongly believe that others suffering like me should be given the option of TMS under the NHS.”

Mr Cox said: “Our economic analysis was informed via feedback from TMS experts across six mental health care services, and from the experiences of 442 participants suffering with difficult-to-treat forms of depression enrolled within two clinical trials. The study found that a proportion of patients receiving TMS therapies can expect to achieve faster and more sustained improvements in depressive symptoms compared to usual care, and that these gains represent a cost-effective allocation of scarce NHS resources.

“It’s important to recognise that the cost-effectiveness of TMS is dependent specifically on how it is going to be delivered in wider practice. Our study findings demonstrate that services that can achieve a streamlined high throughput model of care can expect to deliver a highly cost-effective treatment. Our findings should provide much needed evidence for policymakers to rationalise and establish cost-effective models for implementing TMS within the NHS.”

The team developed a decision-analytic model (DAM) to integrate evidence from three sources – (i) the BRIGhTMIND trial  – a large randomised controlled trial (RTC), funded by the Efficacy and Mechanism Evaluation (EME) Programme - a partnership between the NIHR and the Medical Research Council (MRC) -  that showed TMS was effective for at least six months; (ii) The Specialist Mood Disorder (SMD) trial – the first UK multicentre outpatient RTC in patients with moderate of severe unipolar depression in the UK funded by the NIHR Applied Research Collaboration East Midlands; and (iii) a study-specific structured expert elicitation exercise, where experts highly experienced in the delivery of TMS therapies for depression were interviewed on the longer-term effectiveness and operational realities of providing treatment.

NICE typically considers medical interventions to be cost-effective if the incremental cost-effectiveness ratio (ICER) for a treatment [the expected cost to the health service per unit of benefit] falls within or below a threshold of £20,000–£30,000 per quality-adjusted life-year (QALY) gained. This threshold is set to rise to £25,000–£35,000 per QALY imminently.

From a health-service perspective rTMS and iTBS had ICERs of £12,093 and £12,959 per QALY compared to TAU, respectively. From a broader societal perspective both rTMS and iTBS improved health, reduced informal care hours and were cost-saving compared with TAU.

The study findings were sensitive to service delivery, but provided there is a high throughput of patients receiving TMS and currently recommended protocols for TMS are followed, then this research suggests that TMS is a cost-effective alternative to usual care.  

Professor Richard Morriss, Research Theme Lead for Mental Health and Technology at the NIHR Nottingham Biomedical Research Centre, and the School of Medicine at the University, said: “Our view is that TMS should be considered as a cost-effective alternative for treating moderate to severe depression after the second course of treatment has failed.

“Compared to usual care, our study shows that TMS is cost-effective below the lowest NICE threshold for cost-effectiveness for health costs and cost saving if health, informal care and work productivity are included.

“Two main objections for implementing TMS for TRD in the NHS was that it was only effective for a short period and there was no UK economic study showing that it was cost-effective or cost-saving. The BRIGhtMIND study in 2024 proved that the treatment was effective for at least six months and this new study now shows cost-effectiveness in health costs and in terms of in wider societal costs too. With this in mind, we feel that it is time for the NHS to seriously consider implementing TMS in NHS services across the UK.”

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Journal

BMJ Mental Health

DOI

10.1136/bmjment 

Method of Research

Meta-analysis

Subject of Research

People

Article Title

Is it time for mental health services to invest in neurostimulation? An economic evaluation of transcranial magnetic stimulation therapies for the treatment of moderate to severe treatment-resistant depression in the UK

Article Publication Date

28-Jan-2026