Does E-Cigarette Advertising Increase Consumer Preference for E-Cigarettes? A Systematic Review and Meta-Analysis

Abstract

Background: Studies show that some harmful components of nicotine-containing e-cigarettes are higher than in traditional cigarettes. Whether nicotine-cigarette advertising should be banned has become a hot topic, although there is a lack of comprehensive data analysis on the issue. Our study aimed to assess the association between e-cigarette advertising and consumers’ e-cigarette preferences and provide the basis for formulating a more appropriate e-cigarette advertising policy. Methods: Relevant studies were identified by conducting a literature search via the PubMed, EMBASE, Web of Science, and CENTRAL databases until October 2019. We included randomized controlled trials (RCTs), cohort studies, and cross-sectional studies that reported Odds Ratio (OR) with a 95% Confidence Interval (CI) for the effect of e-cigarette advertising on consumers’ e-cigarette preferences. Results: Fifteen studies, including 94,031 participants, met the inclusion criteria. The pooled OR was 1.34 (95% CI: 1.28-1.40, I2 = 54.0%, P = 0.002). Of 15 studies, 3 cohort studies (OR = 1.32, 95% CI: 1.08-1.56), 5 cross-sectional studies (OR = 1.33, 95% CI: 1.28-1.40), and 7 RCTs (OR= 1.43, 95% CI: 1.17-1.69) were pooled separately via the random-effects model. In the subgroup analyses, the increased preferences were more evident in non-smokers (OR = 1.41, 95% CI: 1.29-1.43), adolescents (OR = 1.54, 95% CI: 1.42-1.66), and participants from the United States (OR = 1.56, 95% CI: 1.42-1.70). Conclusions: This study suggested that e-cigarette advertising was associated with a 34% increase in consumers’ e-cigarette preferences, which could be used to remind policymakers to control e-cigarette advertising, especially for nicotine-containing e-cigarettes. Funding Statement: This study was funded by Huazhong University of Science and Technology Double First-Class Funds for Humanities and Social Sciences. Declaration of Interests: The authors declare that they have no conflict of interests. Ethics Approval Statement: Ethical approval is not required for this systematic review.