Electronic cigarette advertising linked to increased use among students

1. Exposure to electronic cigarette advertising was greater among middle and high school students who use electronic cigarettes compared to nonusers.

2. The odds of electronic cigarette use increased with greater exposure to electronic cigarette advertising, with Internet advertisements having the strongest effect.

Study Rundown: Electronic cigarette (e-cigarette) use has been rapidly rising among adolescents in the United States. As opposed to cigarettes, no federal regulations currently exist for e-cigarette advertising. A large number of outlets promote e-cigarette sales including retail stores, the Internet, and digital and print media. Although previous work has suggested a connection between tobacco advertisement exposure and product use, the influence of different advertisement sources, specifically for e-cigarettes, had not been investigated. By reviewing the results of the 2014 National Youth Tobacco Survey, researchers found that e-cigarette users tended to have greater exposure to e-cigarette advertising. Furthermore, the odds of e-cigarette use were significantly increased in middle and high school students who frequently encountered advertisements when compared to those who rarely or never saw them. Among the outlets considered, frequent Internet advertisement exposure was associated with the largest increase in the odds of e-cigarette use. Reliance upon self-report data collected in a school setting increased the potential risk of response bias. . Additionally, trends over time were not considered. Despite these limitations, clinicians may wish to consider speaking with middle and high school-aged students about the dangers of all tobacco-based products, including e-cigarettes.

Click to read the study, published today in Pediatrics

Relevant Reading: A randomized trial of the effect of e-cigarette TV advertisements on intentions to use e-cigarettes

Study Author, Tushar Singh, MD, PhD, MS, talks to 2 Minute Medicine: Office on Smoking and Health, National Center Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

“E-cigarettes typically contain tobacco-derived nicotine, which is highly addictive, could lead to sustained tobacco use, and may cause lasting harm to brain development among youth. E-cigarettes became the most commonly used tobacco product among U.S. youth in 2014, and e-cigarette advertising uses many of the same themes and tactics that have led to increases in traditional cigarette smoking among youth. Health care providers can ask about youth’s e-cigarette use and provide counseling on dangers of use of all tobacco products among youth, including e-cigarettes; and advise parents and caregivers to actively participate in deciding which websites and media children may view and discuss media content with them.”

In-Depth [cross-sectional survey]: Participants included 10 419 middle school (grades 6 to 8) and 11 399 high school (grades 9 to 12) students who completed the 2014 National Youth Tobacco Survey (NYTS). A binary classification of e-cigarette use was determined based on response to use in the past 30 days (user: ≥1 day; nonuser: 0 days). Exposure to Internet, newspaper/magazine, retail store, and TV/movie e-cigarette advertising was measured categorically and analyzed as “never/rarely,” “sometimes,” and “most of the time/always.” Adjusting for gender, race/ethnicity, grade, and other tobacco use, the odds of using e-cigarettes was significantly (p < 0.05) increased in the “most of the time/always” group relative to the “never/rarely” group across all advertisement sources for both middle and high school students. The greatest increase in odds was observed with exposure to Internet advertising (middle school students: OR = 2.91, 95%CI: 1.89-4.47; high school students: OR = 2.02, 95%CI: 1.66-2.46). A significant (p < 0.05) increase in the odds ratio was also noted for moderate (i.e., those that responded “sometimes”) relative to low/no exposure in the high school students for all advertisement sources but only for Internet and retail store advertisement exposure in the middle school student sample. Of the current middle school e-cigarette users, 31.4% (95%CI: 26.8%-36.4%) had frequent exposure to Internet e-cigarette advertisements compared to only 10.8% (95%CI: 9.5%-12.4%) of the current nonusers. A similar pattern of advertisement exposure was observed among the high school e-cigarette users and nonusers.

Image: CC/Wiki/Lindsay Fox

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