E-cigarette companies currently advertise their products to a broad audience that includes 24 million youth. The dramatic increase in youth and young adult television exposure between 2011 and 2013 was driven primarily by a large advertising campaign on national cable networks. In the absence of evidence-based public health messaging, the current e-cigarette television advertising may be promoting beliefs and behaviors that pose harm to the public health. If current trends in e-cigarette television advertising continue, awareness and use of e-cigarettes are likely to increase among youth and young adults.

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What is already known about this topic?Statewide media campaigns are an evidence-based component of comprehensive tobacco control programs. However, because of budget limitations, few state tobacco control programs can devote resources to both create and consistently air media campaigns.What is added by this report?From 2011 through 2018, the Bureau of Tobacco Free Florida aired hardhitting advertisements from successful national and state campaigns as part of their Tobacco Free Florida campaign. The study found that exposure to the Tobacco Free Florida campaign influenced the rate of quit attempts among adult smokers in Florida.What are the implications for public health practice?Statewide media campaigns can use existing effective advertising materials to affect population-level quit attempts. Abstract ConclusionThe Tobacco Free Florida campaign affected cessation-related behaviors in Florida over an 8-year period. Evidence-based state tobacco education campaigns can accelerate progress toward the goal of reducing adult smoking.

BACKGROUND AND OBJECTIVE Currently, the US Food and Drug Administration does not regulate electronic cigarette (e-cigarette) marketing unless it is advertised as a smoking cessation aid. To date, the extent to which youth and young adults are exposed to e-cigarette television advertisements is unknown. The objective of this study was to analyze trends in youth and young adult exposure to e-cigarette television advertisements in the United States. METHODS Nielsen data on television household audiences’ exposure to e-cigarette advertising across US markets were examined by calendar quarter, year, and sponsor. RESULTS Youth exposure to television e-cigarette advertisements, measured by target rating points, increased 256% from 2011 to 2013. Young adult exposure increased 321% over the same period. More than 76% of all youth e-cigarette advertising exposure occurred on cable networks and was driven primarily by an advertising campaign for 1 e-cigarette brand. CONCLUSIONS E-cigarette companies currently advertise their products to a broad audience that includes 24 million youth. The dramatic increase in youth and young adult television exposure between 2011 and 2013 was driven primarily by a large advertising campaign on national cable networks. In the absence of evidencebased public health messaging, the current e-cigarette television advertising may be promoting beliefs and behaviors that pose harm to the public health. If current trends in e-cigarette television advertising continue, awareness and use of e-cigarettes are likely to increase among youth and young adults.

By quantifying the effect of changes in state-level adult smoking rates on youth smoking, this study enhances the precision with which the tobacco control community can assess the return on investment for adult-focused tobacco control programs.