E-cigarette Advertisements Research Articles

How Age and E-cigarette Use Status Interact to Influence E-cigarette Ad Perceptions

Background: The prevalence of e-cigarette use among young people remains high. Young people are susceptible to e-cigarette advertising, although potential heterogeneity in perceptions of e-cigarette ads with respect to age and e-cigarette use history remains unexplored. We aimed to assess differences in perceptions of e-cigarette ads and product use intention, by age and e-cigarette use status. Methods: Participants from an online convenience sample (N = 497, M age=31.9) viewed two randomly selected e-cigarette ads and reported their perceptions of the ads and product use intention. We used mixed effects linear regression models to estimate associations between age group (18–20 years, 21–25 years, 26+ years), e-cigarette use status (never, former, and current use), and their interaction effects, on outcomes related to perceptions of ads and use intention. Models controlled for demographics and other tobacco use. Results: Current e-cigarette users (vs. never users) and participants who were 26+ years old (vs. 18–20 years old) had greater liking of the ads, perceived ad relevance, and perceived ad effectiveness. Among current e-cigarette users, participants who were 26+ years old (vs. 18–20 years old) had lower use intention. Conclusion: The effect of e-cigarette ad exposures on perceptions of the ad and use intention is heterogeneous with respect to age group and e-cigarette use history. While ads appealed more to adults who were 26+ years old across e-cigarette use groups, current e-cigarette users who were 18–20 years old demonstrated high use intention following ad exposure, suggesting a need for marketing interventions to mitigate continued e-cigarette use among young people.

Young people's support for various forms of e-cigarette regulation in Australia and the UK.

The aim of this study was to examine young people's support for e-cigarette policies in two countries with very different e-cigarette regulatory environments - Australia and the UK. An online survey was administered to 1,185 15-24 year olds (590 from Australia, 595 from the UK). Survey items assessed demographics, use of vaping and tobacco products, exposure to others' vaping behaviours, exposure to e-cigarette advertising, perceptions of harms associated with e-cigarettes, and support for 14 e-cigarette policies. Frequencies for support were calculated for each policy by country and overall, and a mixed effects negative binomial regression was performed to identify factors associated with support. Majority support was expressed for 10 of the 14 policies in the Australian sample and six in the UK sample. Significantly higher levels support were found among Australian respondents compared to UK respondents for all policies except one where the difference failed to reach statistical significance. Support was strongest for policies relating to preventing access by minors, including warnings on packages, and prohibiting misleading advertising. Support was weakest for policies restricting access to e-cigarettes and flavours. Factors associated with higher levels of support were harm perceptions, never having used e-cigarettes, and older age. The results suggest general support for a broad range of e-cigarette control policies among young people in Australia and the UK, despite very different e-cigarette regulatory environments in these countries. Enhancing awareness of the potential harms associated with e-cigarette use appears to be key to optimising support for the assessed policies among members of this age group.

Prevalence, Knowledge, and Attitudes among Health Professions Students toward the Use of Electronic Cigarettes.

Healthcare professionals are standing against the widespread use of e-cigarettes among the population, especially young adults. E-cigarettes are generally introduced, especially via social media platforms, as a safer alternative to conventional cigarette smoking. The aim of this study was to measure the prevalence of e-cigarette use among healthcare professions students at the University of Jordan, as well as to explore their knowledge and attitudes toward the use of e-cigarettes. An anonymous Google-Form®-based cross-sectional questionnaire was presented to potential participants at the University of Jordan. Students' responses were analyzed using SPSS® 23.0 software. A total of 679 online surveys were completed. About 37.4% of students reported using e-cigarettes at least once in their lifetime and about 20% of students were current e-cigarette users. The multivariate analysis showed that the factors associated with E-cigarette smoking are being male, having mothers, siblings, or friends using e-cigarettes, having easy access to e-cigarettes, and having social media as the main source of knowledge regarding e-cigarettes. The relatively high acceptance level and use of e-cigarettes among health professions students should be an alarming sign to decision-makers to give more attention to legislation that controls tobacco products including e-cigarette selling and advertising.

The effect of vaping cues in e-cigarette advertisements on normative perceptions about cigarettes among young adults who use cigarettes and e-cigarettes in Boston

IntroductionE-cigarette advertising frequently involves vaping cues–hand to mouth motions and vapor–that physically resemble traditional cigarette smoking cues. There has been concern that these vaping cues could make cigarettes seem more frequently used and acceptable by society. This analysis examined whether exposure to vaping cues in e-cigarette ads influence descriptive and injunctive normative perceptions about cigarettes among young adults who use cigarettes and e-cigarettes (dual use). MethodSecondary analysis was conducted on an experiment that randomly exposed young adults living in Boston who dual used in the past-week to either 1) E-cigarette ads with vaping cues; 2) E-cigarette ads that edited out vaping cues; or 3) Beverage ads. Descriptive and injunctive normative perceptions about cigarettes were compared across participants who viewed e-cigarette ads with vaping cues versus those who viewed ads without vaping cues. ResultsThose who viewed e-cigarette ads with vaping cues had decreased perceptions that cigarette smoking was common compared to those who viewed e-cigarette ads without vaping cues. Exposure to e-cigarette ads with vaping cues also led to increased perceptions of other peoples’ unfavorable views toward cigarette smoking in general and their own cigarette smoking. ConclusionContrary to renormalization concerns, vaping cues in e-cigarette ads increased anti-smoking normative perceptions among people who dual used in the past week. Further research is needed to examine the impact of vaping cues in e-cigarette ads on normative perceptions among those who don’t smoke or quit smoking cigarettes.

Adolescents' views on user-generated content and influencer marketing of e-cigarettes on social media: a focus group study

BackgroundEvidence suggests that experimentation and use of electronic cigarettes (e-cigarettes) is increasing. E-cigarettes are widely promoted on the internet, and user-generated content and influencer marketing on social media represents an important influence in shaping pre-adolescents and adolescents' understanding of issues and products. We aim to explore pre-adolescents and adolescents' responses to, and engagement with, e-cigarettes and the broader e-cigarette marketing environment, including user-generated and influencer content. Methods20 focus groups were conducted between March and May, 2022, with 82 pre-adolescents and adolescents aged 11–16 years living in the central belt area of Scotland, UK. Participants were asked about smoking and vaping behaviours, social media use, vaping advertisement exposure, and were shown illustrative examples of typical social media content (eg, images and videos), which were used to stimulate discussion about different messages, presentations, and contextual features. Focus groups were audio-recorded, transcribed verbatim, and coded by means of thematic analysis methods. FindingsParticipants mentioned seeing e-cigarette advertising mostly through social media platforms, such as Instagram and TikTok. Youths agreed that e-cigarettes portrayed on social media were often glamorised as being “cool”, “fashionable”, enticing by social media influencers, and viewed as a modern lifestyle accessory. Participants typically viewed e-cigarettes as less harmful than traditional cigarettes, but also expressed concerns about the scarcity of health and age warnings (ie, cautioning against use by individuals younger than 18 years) on social media, which was viewed as problematic, especially for younger children who spend time on these social media platforms. Participants stated that the adverts were branded to target their age group and that the e-cigarette flavourings encouraged youths to want to try the products, particularly sweet flavourings. InterpretationGiven the high level of pre-adolescents and adolescents' engagement with social media, these findings provide worrying evidence that e-cigarettes are attractive to this population group. Our findings suggest the growing need for governments to work together to develop and implement policies to restrict the advertising and marketing of e-cigarettes on social media. In addition, social media platforms should consider implementing more robust measures, such as age and health warnings, to ensure the prevention of vaping-related content targeted at underage users. FundingCancer Research UK, UK Medical Research Council, and UK Chief Science Office.

E-Cigarette Use among University Students from One University in Hanoi, Vietnam, and Associated Factors.

Describe the use of e-cigarettes and factors associated with e-cigarette use among university students from one university in Vietnam in 2021. This cross-sectional study was conducted with a total of 554 full-time undergraduate students recruiting for the study. Data was collected using a structured self-administered questionnaire. A logistic regression analysis was performed to identify factors with significant association with students' use of e-cigarettes. The study revealed that 13.2% of students were current users. Students who had e-cigarette smokers in the family (aOR=6.1, 95% CI: 2.5-15.4; p<0.001), used traditional cigarettes (aOR=23.6, 95% CI: 10.5-53.4; p<0.001), consumed alcohol (aOR=5, 95%CI: 1.6 - 15.9; p<0.01), were exposed to e-cigarette advertising (aOR=2.6; 95%CI: 1.1-5.9; p<0.01), and had inadequate knowledge about e-cigarettes (aOR=2.2; 95%CI: 1-4.7; p<0.01) were more likely to use e-cigarettes. This study updates the status of e-cigarette use among students in one university in Vietnam, thereby suggesting strategies to reduce the use of e-cigarettes among university students.

Association between E-Cigarette Advertising Exposure and Use of E-Cigarettes among a Cohort of U.S. Youth and Young Adults.

Youth and young adult (YYA) use of e-cigarettes increased rapidly between 2010 and 2019 in the United States, during which exposure to e-cigarette advertising was also increased. We aimed to examine whether exposure to e-cigarette advertising among YYAs may lead to subsequent e-cigarette use. A cohort of 3886 YYAs ages 13–24 was recruited from two survey panels in 2018 and followed up until 2019. Survey data were collected online and by telephone. The primary outcome was past 30-day use of e-cigarettes at the follow-up survey. Among 2304 YYAs who retained at the follow-up survey and were not past 30-day e-cigarette users at baseline, both youth and young adults exposed to e-cigarette advertising at baseline had elevated odds of past 30-day e-cigarette use at follow-up (Youth adjusted odds ratio (aOR): 2.77, 95% CI: 1.23, 6.24; Young adults aOR: 2.34, 95% CI: 1.08, 5.11) compared with those not reporting baseline advertising exposure. The majority of YYAs reported exposure to e-cigarette advertising at baseline (Youth: 63.7%, 95% CI: 59.8, 67.4; Young adults: 58.3%, 95% CI: 53.6, 62.8). Our findings suggest that exposure to e-cigarette advertising was associated with an increase in subsequent past 30-day use of e-cigarettes among YYAs. Restricting advertising targeted at YYAs may reduce the likelihood of e-cigarette use among YYAs.

Association of e-Cigarette Advertising, Parental Influence, and Peer Influence With US Adolescent e-Cigarette Use

Little is known about the roles of advertising and parental and peer influence in e-cigarette use among US adolescents in recent years, hindering efforts to address the increasing rate of youth vaping. To examine how e-cigarette advertising exposure and parental and peer e-cigarette use were associated with e-cigarette use among US adolescents. This cohort study used data from waves 4 (December 2016 to January 2018), 4.5 (December 2017 to December 2018), and 5 (December 2018 to November 2019) of the Population Assessment of Tobacco and Health study, an on-going cohort study representative of the noninstitutionalized US population. Sample weights were applied to generate nationally representative estimates. Data were analyzed in January 2022. Past 30-day e-cigarette advertising exposure, past 30-day parental e-cigarette use, and the number of best friends using e-cigarettes (none, a few, some, most, and all). Outcomes were contemporary curiosity about using e-cigarettes and e-cigarette initiation at follow-up. Generalized estimating equations were used to estimate the weighted adjusted associations. Wave 4 included 8548 adolescents; wave 4.5, 10 073 adolescents; and wave 5, 11 641 adolescents. Among adolescents in the wave 4 survey, 4425 (51.1%) were boys, 1935 (24.9%) were aged 12 years, 1105 (13.0%) were Black, 2515 (24.4%) were Hispanic, and 3702 (52.3%) were White. More than 60% of adolescents reported past 30-day e-cigarette advertising exposure at each survey. Among adolescents who had never used e-cigarettes, those who reported e-cigarette advertising exposure were more likely to feel curious about using e-cigarettes (adjusted odds ratio [aOR], 1.56 [95% CI, 1.43-1.70]) and were more likely to become ever e-cigarette users (aOR, 1.21 [95% CI, 1.05-1.41]) and current e-cigarette users (aOR, 1.42 [95% CI, 1.16-1.75]) at follow-up. Adolescents who reported having best friends using e-cigarettes were more likely to feel curious about using e-cigarettes (eg, all best friends: aOR, 4.13 [95% CI, 2.35-7.26]) and initiate e-cigarette use at follow-up (eg, among adolescents reporting all best friends use e-cigarettes, risk of ever use: aOR, 4.08 [95% CI, 1.44-11.59]; risk of current use aOR, 5.42 [95% CI, 1.49-19.72]) than adolescents who reported having no best friends using e-cigarettes. This cohort study of US adolescents found that e-cigarette advertising and peer influence were significantly associated with e-cigarette initiation. Efforts to address youth vaping need to consider peer influence and incorporate measures reducing e-cigarette advertising exposure.

Association of Non-Cigarette Tobacco Advertisements and Racial Discrimination With Non-Cigarette Tobacco Product Use Among Black Adults.

Black communities are targeted by more cigarette advertisements than White communities and racial discrimination among Black people is related to cigarette use. However, little is known about these factors with non-cigarette tobacco product use among Black adults. Therefore, this study assessed the association of non-cigarette advertisement exposure and racial discrimination with use of non-cigarette tobacco products among Black adults. Black adults (n = 533) from The Family and Community Health Study in 2016 were asked if they had seen advertisements for e-cigarettes, snus pouches, filtered cigars, large cigars, cigarillos, dissolvable tobacco, smokeless tobacco, hookah, and tobacco pipe and if they used these in the past month. For products with the highest past month use and significant correlations with advertisement exposure, separate logistic regression models were performed that evaluated the association between advertisement exposure, racial discrimination, and non-cigarette tobacco product use while controlling for cigarette use, sex, socioeconomic status, and age. Use of cigarillos, large cigars, and hookah were higher than other non-cigarette tobacco products assessed. Logistic regressions revealed that more advertisement exposure in the past month was associated with higher odds of using cigarillos, large cigars, and hookah (p < .01). More experiences of racial discrimination were associated with past month cigarillo use, but not hookah or large cigars (p < .01). Non-cigarette tobacco advertisement exposure was associated with the use of non-cigarette tobacco products. Experiences of racial discrimination were associated with the most used non-cigarette tobacco product among Black adults, cigarillos. This is the first time that a specific type of cigar (ie cigarillos) has been associated with experiences of racial discrimination among Black adults. Efforts to reduce non-cigarette tobacco marketing and eradicate exposure to racial discrimination among Black adults may aid in eliminating tobacco-related health disparities.

E-cigarette Marketing Expenditures in the United States From 2016 to 2021: Targeted Media Outlets Geared Toward People Who Are at Increased Risk for Tobacco Use.

E-cigarette advertising exposure is linked to e-cigarette initiation and use. Thus, monitoring trends in e-cigarette advertising practices is important to understand e-cigarette use patterns observed over recent years. E-cigarette advertising expenditures (January 2016-July 2021; Numerator Ad Intel) for 154 U.S. market areas were harmonized with U.S. Census sociodemographic data through Nielsen zip code designations by market area. Descriptive statistics and multivariable linear regressions were used to examine trends in e-cigarette advertising expenditures across media outlets and associations between sociodemographic characteristics and e-cigarette advertising over time. E-cigarette advertising expenditures peaked in 2018/2019, followed by a sharp decline in 2020. Expenditures were concentrated primarily on print (58.9%), TV (20.6%), and radio (14.4%). Major print outlets were Sports Illustrated, Rolling Stone, and Star magazines. Top TV channels were AMC, Investigation Discovery, and TBS. TV advertisements were purchased commonly during popular movies and TV series (eg King of Queens, Everybody Loves Raymond, The Walking Dead). Higher expenditures were associated with U.S. market areas that had (1) a larger percentage of non-rural zip codes (radio), (2) smaller male populations (radio), and (3) larger White or Caucasian, Black or African American, American Indian or Alaska Native, Asian, and Other or Multiracial populations (radio, print, online display, and online video). E-cigarette companies advertised in print magazines geared toward males and youth and young adults, radio commercials focused in urban areas with smaller male populations, and nationwide TV commercials. Declines in e-cigarette advertising expenditures in 2020 demonstrate the potential impact that federal policies may have on protecting populations who are at higher risk for tobacco use from predatory advertising practices. E-cigarette advertising exposure is associated with the initiation and use of e-cigarettes. This study shows how e-cigarette marketing expenditures in the United States may have targeted specific consumers (eg youth and young adults) between 2016 and 2021. The precipitous drop in advertising expenditures across all outlets during early 2020 corresponds with the implementation of the Tobacco 21 federal policy, the federal enforcement policy to remove most unauthorized flavored e-cigarette cartridges from the U.S. market, preparations for FDA's premarket review of e-cigarette products, and the decision by several TV broadcast companies to stop showing e-cigarette ads. The potential impact of federal policies may have far-reaching implications for protecting populations who are at high risk for tobacco use and its health consequences.

How the Other Half Sees It: E-cigarette Advertising Exposure and Subsequent E-cigarette Use Among U.S. Young Adult Cigarette Smokers.

E-cigarette advertising may benefit young adult cigarette smokers in transitioning to using e-cigarettes. We assessed whether e-cigarette advertising exposure was associated with subsequent e-cigarette use among young adult cigarette smokers. Data were from Waves 4 (2016-2018) and 5 (2018-2019) of the nationally representative Population Assessment of Tobacco and Health (PATH) study adult survey. Respondents were young adult established cigarette smokers at Wave 4 (18-34 years; n = 3391) and a subsample of those who tried to quit smoking cigarettes completely in the past year at Wave 5 (n = 1235). Multivariable logistic regressions were used to examine the associations between e-cigarette advertising exposure (by channel of exposure) and subsequent past-year e-cigarette use in general and e-cigarette use to quit smoking cigarettes, controlling for covariates. At Wave 5, 43.4% of smokers reported past-year use of e-cigarettes; and 14.8% of smokers who tried to completely quit smoking reported past-year use of e-cigarettes to quit. E-cigarette advertising exposure was associated with subsequent past-year e-cigarette use (adjusted odds ratio [AOR] = 1.53, p < .0001, 95% confidence interval [CI] = 1.27, 1.86) and past-year use to quit smoking cigarettes (AOR = 1.65, p < .01, 95% CI = 1.19, 2.29). Advertising exposure through brick-and-mortar stores or websites/social media was similarly associated with both e-cigarette use behaviors. Exposure to e-cigarette advertising among U.S. young adult established cigarette smokers may be associated with subsequent e-cigarette use and use to quit smoking. More research is needed to understand the features of e-cigarette advertising (eg, discounts, flavors, smoker-targeted claims) that may shape perception and behavior related to e-cigarette use among young adult smokers. Little is known about the associations between e-cigarette advertising exposure and e-cigarette use among young adult cigarette smokers who may benefit from switching to e-cigarettes. This study found that e-cigarette advertising exposure was positively associated with (1) subsequent e-cigarette use among U.S. young adult established cigarette smokers and (2) subsequent e-cigarette use to quit smoking cigarettes among those who tried to completely quit in the past year. These observed associations were driven by smokers who did not currently use e-cigarettes at baseline. E-cigarette advertising exposure through brick-and-mortar stores or websites/social media was also positively associated with subsequent e-cigarette use behaviors.

Electronic Cigarettes Use and Pharmacological Strategies as an Intervention for Tobacco Cessation

Tobacco use is a single leading preventable cause of death worldwide. It contains nicotine, which is one of the most addictive psychoactive drugs; thus, successful quitting becomes a challenging process. Occupation has a profound influence on tobacco use patterns, and in the majority of scenarios, users are unable to achieve abstinence to maintain the need for the psychoactive effect of nicotine to cope up with job stresses and to remain energetic. Various tobacco cessation aids are available with variable success rates. Electronic cigarettes (e-cigarettes) or vaping has become popular, particularly in Western Countries and among occupational workers as they contain less harmful chemicals than combustible cigarettes and can help heavy smokers to quit the habit. Reports of short- and long-term health effects of vaping have currently led to a ban on the production, manufacturing, and advertising of e-cigarettes. Pharmacological interventions such as bupropion and varenicline have been proven to provide long-term abstinence; however, neuropsychiatric side effects limit their use. This paper focusses on the hypothesis that whether the electronic nicotine delivery system (ENDS) or vaping and pharmacological interventions are an effective tobacco cessation interventions.

The Mediating Effect of E-Cigarette Harm Perception in the Relationship between E-Cigarette Advertising Exposure and E-Cigarette Use.

Exposure to e-cigarette advertising is associated with e-cigarette use among young people. This study examined the mediating effect of e-cigarette harm perception on the above relationship. Cross-sectional survey data were collected from 2112 college students in New York City in 2017–2018. The analytic sample comprised 2078 participants (58.6% females) who provided completed data. Structural equal modeling was performed to examine if e-cigarette harm perception mediated the relationship between e-cigarette advertising exposure (via TV, radio, large signs, print media, and online) and ever e-cigarette use and susceptibility to e-cigarette use. About 17.1% of participants reported ever e-cigarette use. Of never users, 17.5% were susceptible to e-cigarette use. E-cigarette advertising exposure was mainly through online sources (31.5%). Most participants (59.4%) perceived e-cigarettes as equally or more harmful than cigarettes. Advertising exposure showed different effects on e-cigarette harm perception depending on the source of the advertising exposure, but perceiving e-cigarettes as less harmful than cigarettes was consistently associated with e-cigarette use and susceptibility. Low harm perception mediated the association between advertising exposure (via online, TV, and radio) and ever e-cigarette use and between online advertising exposure and e-cigarette use susceptibility. Regulatory actions are needed to address e-cigarette marketing, particularly on the Internet.

Exposure to e-cigarette advertising and provaping websites, and the social acceptability of their use among nicotine users.

ABSTRACTObjectives.To evaluate the prevalence of exposure to Internet communications on and advertising of electronic cigarettes (e-cigarettes) and their association with perceptions of the social acceptability of e-cigarettes in Mexico.Methods.Data were analyzed from eight surveys (2018–2021) of an online sample of Mexican adult (> 18 years) smokers and dual users (of combustible and electronic cigarettes). Self-reported exposure to e-cigarette advertising across various marketing channels was assessed, as well as visits to e-cigarette websites. Logistic regression analysis was used to evaluate the association between perceptions of the social acceptability of e-cigarette use and level of advertising exposure and visits to e-cigarette websites.Results.The Internet and outside e-cigarette stores were where exposure to advertising most occurred, as reported by 47.4% and 46.8% of respondents, respectively. Respondents who noticed e-cigarette advertisements on the Internet (adjusted odds ratio (OR) 1.43, 95% confidence intervals (CI) 1.25, 1.63), outside e-cigarette stores (adjusted OR 1.31, 95% CI 1.14, 1.50), and in temporary outlets (adjusted OR 1.16, 95% CI 1.01, 1.34), and those who visited e-cigarette websites (adjusted OR 1.48, 95% CI 1.25, 1.76) were more likely to perceive e-cigarettes as socially acceptable. Noticing advertisements across more channels was also associated with higher perceived social acceptability of e-cigarette use.Conclusions.Being exposed to e-cigarette marketing, either online or through traditional marketing channels, is associated with perceived social acceptability of e-cigarette use, as is contact with provaping sites. Regulatory options to avoid the proliferation of promotional websites disguised as opinion or user sites need to be considered.

Impact of vaping introduction on cigarette smoking in six jurisdictions with varied regulatory approaches to vaping: an interrupted time series analysis

ObjectiveWe sought to quantify the impact of vaping introduction on cigarette smoking across settings with varied regulatory approaches to vaping.DesignInterrupted time series analysis, adjusted for cigarette tax levels.SettingFour Canadian provinces,...

Is Exposure to Social Media Advertising and Promotion Associated with E-cigarette Use? Evidence from Indonesia.

Background:E-cigarette use is a growing public health concern globally, including in Indonesia. Objective:Our study aimed to assess whether exposure to advertising and promotion in social media is associated with e-cigarette use in Indonesia, an upper-middle-income country. Methods:We conducted mixed-method research including quantitative and qualitative methods. For the quantitative methods, we did an online survey in the five largest cities in the country with 1,239 participants during September-October 2020. For the qualitative method, we conducted an in-person focused group discussion during November 2020 (while complying to the COVID-19 protocols). Results:We found high rates of e-cigarette ever use (29%) and current use (13%) among study participants. There was high exposure to e-cigarette advertising and promotion in social media, with a majority of participants (84%) reported ever seeing e-cigarette adverts or promotions on Facebook, Instagram, YouTube, and others. Both high rates of e-cigarette use and exposure to social media advertising are associated. Participants reported ever seeing adverts and promotions were 2.91 times and 2.82 times more likely ever to use and currently use e-cigarettes, respectively, after controlling for socioeconomic factors, region, and cigarette smoking status. Conclusion:Exposure to social media advertising and promotion is associated with e-cigarette use in Indonesia.

Trajectories of e-cigarette advertising exposure, e-cigarette use and cigarette smoking in a sample of young adults from Hawaii.

To test whether intrapersonal growth in e-cigarette advertising exposure over time is associated with growth in e-cigarette use and/or cigarette smoking. Longitudinal study using four waves of data were collected in 6-month intervals between 2018 and 2020. Participants were 2327 young adults recruited from colleges in Hawaii, USA. Data were collected on demographics, e-cigarette advertising exposure measured using the cued- recall method and recent (past 30-day) cigarette and e-cigarette use. The average trajectory for e-cigarette advertising exposure over time was significant and upward [M slope = 0.18 (0.14-0.22), P < 0.0001]. However, average trajectories for e-cigarette [M slope = -0.08 (-0.18 to 0.02), P = 0.09] and cigarette [M slope = -0.14 (-0.30 to 0.02), P = 0.07] use were not. There were significant differences in individual level trajectories across participants for advertising exposure [σ2 = 0.12 (0.10-0.14), P < 0.0001], e-cigarette use [σ2 = 0.22 (0.14-0.30), and cigarette smoking (σ2 = 0.17 [0.09-0.25], P < 0.0001). Individuals with an increasing rate of advertising exposure showed an increasing rate of e-cigarette use [B = 0.63 (0.36-0.90), P < 0.0001). Neither initial level of, nor rate of change in, advertising exposure was significantly associated with cigarette smoking growth factors (P > 0.05). Higher initial level of e-cigarette use was associated with higher initial level of cigarette smoking [B = 0.89 (0.69-1.09), P < 0.0001] but decreased rate of cigarette smoking over time [B = -0.12 (-0.20 to -0.04) P = 0.003]. Rate of change in e-cigarette use was not associated with the rate of change in cigarette smoking (P > 0.05). Increased exposure to e-cigarette advertising appears to be associated with increased e-cigarette use but not with increased cigarette smoking. Higher initial level of e-cigarette use appears to be associated with higher initial level of cigarette smoking but may be associated with a decreasing rate of cigarette smoking over time.

Electronic cigarette use among sexual minority and heterosexual young adults in a U.S. national sample: Exploring the modifying effects of advertisement exposure

Sexual minorities demonstrate disparities in traditional cigarette use and nicotine-related health consequences. Electronic cigarette (e-cigarette) use is increasing, particularly among adolescents and young adults. Sexual minorities have been found to use e-cigarettes at higher rates than heterosexuals, but little is known about reasons for this disparity. The present study examined characteristics of current and lifetime e-cigarette use between sexual minority and heterosexual young adults (18–34; N = 14,174) using a U.S. national sample from the Population Assessment of Tobacco and Health (PATH) Survey–Wave 3. Sexual minority young adults were hypothesized to have higher rates of current and lifetime e-cigarette use and higher rates of exposure to e-cigarette advertisements. These exposures were hypothesized to moderate the relationship between sexual minority status and current e-cigarette use. Results revealed that sexual minority respondents demonstrated greater risk of current e-cigarette use after adjusting for several covariates (e.g., sex, age, lifetime cigarette use). However, advertisement exposures did not moderate the relationship between sexual minority status and current e-cigarette use. In contrast, sexual minority status was not associated with lifetime e-cigarette use after controlling for covariates. Post-hoc tests revealed that sexual minority status was associated with heightened risk of current and lifetime e-cigarette use only among females. This is the first study to examine the impact of e-cigarette advertising across expanded settings, including point of sale locations (e.g., retail, bars, festivals), while exploring differences in current and lifetime e-cigarette use among sexual minority and heterosexual males and females.

Point of Sale Advertising and Promotion of Cigarettes, Electronic Cigarettes, and Heated Tobacco Products in Warsaw, Poland-A Pilot Study.

Prevalence of smoking and e-cigarette use among teenagers in Poland is high. Polish law bans most advertising and promotion for cigarettes, e-cigarettes, and heated tobacco products (HTPs). This study investigates marketing for these products at points of sale (POS) near secondary schools in Warsaw, Poland, noting if the advertising and promotion were allowed under current Polish laws. All POS within 250 m radii of five selected secondary schools in each of three Warsaw districts were assessed for tobacco and e-cigarette direct advertising, inside and outside; offers of gifts or promotional discounts; tobacco merchandising, and tobacco displays. Of the 112 POS surveyed, 83% exposed customers to some form of advertising or promotion of cigarettes, e-cigarettes, or HTPs; in 76%, advertising or promotion that violated Polish law was present. More than 80% of POS surveyed displayed tobacco products; in 19%, these products were displayed near products of interest to minors. POS density observed here was 30.3 per km2, higher than in other European cities. In Poland, a high proportion of POS near schools violates the law banning the advertisement and promotion of tobacco and nicotine consumer products through a dense tobacco retailer network.

How Does Online e-cigarette Advertisement Promote Youth’s e-cigarettes Use? The Mediating Roles of Social Norm and Risk Perceptions

ABSTRACT The adoption of the internet, social media, and e-cigarettes are on the rise among U.S. youth. Uses of social media and online platforms increase the probability for youth to encounter e-cigarette advertisements. Departing from this line of reasoning, we examine the underlying mechanisms of how online e-cigarettes exposure promotes youth’s e-cigarette use. Drawing on insights from the social construction of risk model, this study looks at how perceived social norms and risk perception mediate the link between online e-cigarette advertisement exposure and e-cigarette use. Youth aged 12–17 from the Public Assessment of Tobacco and Health (PATH) Study Waves 2–4 (2014–2018) were included (N = 6,067). Controlling for demographic and other known risk factors for e-cigarette use, respondents who had been exposed to online e-cigarette ads at Wave 2 perceived higher levels of positive social norms of e-cigarette use at Wave 3 (β = 0.13, p < .001) which was associated with lower e-cigarette risk perception at Wave 3 (β = −0.22, p < .001). Lower e-cigarette risk perception at Wave 3 resulted in a higher likelihood of e-cigarette use at Wave 4 (AOR = 0.51, p < .001). Online e-cigarettes ads exposure at Wave 2 predicted e-cigarette use at Wave 4 (AOR = 1.87, p < .001). The results indicate that norm perception associated with online e-cigarettes ads may twist youth’s e-cigarette risk perception that is associated with subsequent usage. Interventions to curb youth’s e-cigarette use can target social norms of e-cigarette use and restrict e-cigarette advertisement exposure to youth.