A scoping review on disparities in exposure to advertising for e-cigarettes and heated tobacco products and implications for advancing a health equity research agenda

Graziele Grilo,Joanna E Cohen,Elizabeth Crespi

doi:10.1186/s12939-021-01576-2

Graziele Grilo, Joanna E Cohen + Show 1 more

Open Access

https://doi.org/10.1186/s12939-021-01576-2

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Abstract

BackgroundDisparities in exposure to and density of tobacco advertising are well established; however, it is still unclear how e-cigarette and heated tobacco product (HTP) advertising vary by age, education, sex, gender identity, race/ethnicity, sexual orientation, socioeconomic status (SES), and/or urban/rural area. Through a scoping review, we sought to identify potential disparities in exposure to e-cigarette and HTP advertising and promotion across populations.MethodsIn January 2020, a systematic literature search was conducted in five databases: PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. The search was updated in October 2020. Articles reporting on exposure to e-cigarette and/or HTP advertising and promotion across age, education, sex, gender identity, race/ethnicity, sexual orientation, SES, and/or urban/rural areas were included for full-text review (n = 25). Of those, 15 were deemed relevant for data extraction.ResultsThe majority of the studies were from the U.S. (n = 12) and cross-sectional (n = 14). Studies were published between 2014 and 2020 and focused on determining causal relationships that underlie disparities; only one study assessed HTP advertising and promotion. Exposure to e-cigarette and HTP advertising was assessed at the individual-level (e.g., recall seeing ads on television) and at the neighborhood-level (e.g., ad density at the point-of-sale). Studies addressed differences across age (n = 6), education (n = 2), sex (n = 6), gender identity and sexual orientation (n = 3), race/ethnicity (n = 11), SES (n = 5), and urban/rural (n = 2). The following populations were more likely to be exposed to e-cigarette advertising: youth, those with more than a high school diploma, males, sexual and gender minorities, Whites, and urban residents. At the neighborhood-level, e-cigarette advertisements were more prevalent in non-White neighborhoods.ConclusionsExposure to e-cigarette/HTP advertising varies based on sociodemographic characteristics, although the literature is limited especially regarding HTPs. Higher exposure among youth might increase tobacco-related disparities since it can lead to nicotine/tobacco use. Research should incorporate and apply a health equity lens from its inception to obtain data to inform the elimination of those disparities.

Highlights

Factors such as housing, discrimination, employment, and education have been shown to impact individual and population-level health, resulting in systematic and avoidable health disparities among certain populations [1,2,3]
This paper aims to fill this gap by answering the following questions: (1) According to the current literature, how does e-cigarette/heated tobacco product (HTP) advertisement exposure differ across race/ethnicity, age, education, sex, gender identity, sexual orientation, socioeconomic status (SES), and/or urban/rural areas? (2) In which generations of the Health Equity Action Research Trajectory (HEART) framework can the available literature be categorized? Understanding the disparities that exist in e-cigarette/HTP advertising and gaps in the literature may guide future research and allow for more effective action on eliminating tobacco-related disparities and advancing health equity
Exposure to e-cigarette advertising and promotion by sociodemographic characteristic was measured at the individual level, with some studies assessing different channels of exposure, and at the neighborhood level, focusing on different points-of-sale (POS)

Summary

Introduction

Discrimination, employment, and education have been shown to impact individual and population-level health, resulting in systematic and avoidable health disparities among certain populations [1,2,3]. Previous research has shown that the tobacco industry has targeted populations that have been excluded or marginalized; a systematic review of the literature found elevated tobacco advertising in lower income neighborhoods [9]. Evidence suggests the tobacco industry creates product brand identities targeting certain populations [11]. This purposive targeting is concerning, as evidence has shown that tobacco advertising can reinforce beliefs that tobacco use is normal [11, 12]. Disparities in exposure to and density of tobacco advertising are well established; it is still unclear how e-cigarette and heated tobacco product (HTP) advertising vary by age, education, sex, gender identity, race/ethnicity, sexual orientation, socioeconomic status (SES), and/or urban/rural area. We sought to identify potential disparities in exposure to e-cigarette and HTP advertising and promotion across populations

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