1. Youth (middle and high school students) and young adults (college students) who had never used electronic nicotine delivery systems (ENDS) but recalled exposure to ENDS marketing on baseline survey had higher odds of initiating ENDS use at 2.5-year follow-up, compared to those who did not recall marketing exposure.
2. ENDS marketing in retail stores was associated with significantly higher odds of ENDS initiation in both youth and young adults, and TV marketing was associated with significantly higher odds of ENDS initiation in young adults.
Evidence Rating Level: 2 (Good)
Study Rundown: In recent years, ENDS use among youth and young adults has continued to rise. Little is known about the factors that may impact initiation of use, such as industry marketing. In this prospective cohort study, researchers used data from surveys conducted among middle school, high school, and college students in Texas. Participants initially reported never starting ENDS use and researchers measured student recall of exposure to ENDS marketing and subsequent initiation of ENDS use on follow-up. Among middle and high school students, recall of exposure to ENDS marketing in retail stores was associated with twice higher odds of ENDS initiation after 2.5-year follow-up, after adjusting for sociodemographics, other tobacco use, and peer ENDS use. College students who recalled exposure to TV or retail store exposure to ENDS marketing at baseline had significantly higher odds of ENDS initiation compared to those who did not.
These findings are limited by a geographically limited sample and reliance on self-reported data. Furthermore, the outcome measured does not contain information regarding frequency or amount of ENDS use. Nonetheless, the study is strengthened by its large sample and study of a previously underexplored exposure. For physicians, these findings highlight an important risk factor when screening for ENDS initiation and identify an avenue for advocacy to prevent rising ENDS use among youth.
In-Depth [prospective cohort]: Researchers used survey data from the Tobacco Center of Regulatory Science on Youth and Young Adults, collected from 4711 students enrolled in middle school, high school, and college in Texas who reported never having used ENDS at baseline in 2014. Participants completed surveys every 6 months through the spring of 2017. Surveys measured baseline recall of exposure to ENDS marketing through TV, radio, billboards, retail stores, and internet, as well as sociodemographic covariates. The primary outcome measured was ENDS initiation during the follow-up period. The association between recalled ENDS marketing exposure and ENDS initiation was assessed using logistic regression, with adjustment for sociodemographics, other past-30-day tobacco use, sensation seeking, and peer ENDS use.
Youth who recalled exposure to retail store ENDS marketing had 1.99 times higher odds of ENDS initiation compared to those who did not (adjust odds ratio [aOR] = 1.99; 95% confidence interval [CI] 1.25-3.17). Young adults had higher odds of ENDS initiation if they recalled ENDS marketing exposure via TV (aOR = 1.29; 95%CI 1.03-1.63) and retail stores (aOR = 1.30; 95%CI 1.05-1.61).
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