E-cigarette adverts and children’s perceptions of tobacco smoking harms: an experimental study and meta-analysis

Vasiljevic, Milica; Wallis, Amelia St John; Codling, Saphsa; Couturier, Dominique‐Laurent; Sutton, Stephen; Marteau, Theresa M.

doi:10.1136/bmjopen-2017-020247

Cited by 12 publications

(12 citation statements)

References 35 publications

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“…This is consistent with observational studies examining exposure to e-cigarette advertisements 20. The cross-cueing effects we observed are also consistent with other experimental studies examining the impact of exposure to e-cigarette advertisements 29. This study therefore extends the existing literature on cross-cueing effects, providing reasons to be concerned about the potential impact of e-cigarette marketing in retail settings.…”

Section: Discussionsupporting

confidence: 90%

“…A susceptibility to using e-cigarettes measure was adapted from the susceptibility to smoking measure and assessed among never vapers only. A perception of harm of smoking was assessed among all participants using the following question:29 30 “How dangerous do you think it is to smoke one or two cigarettes occasionally?” (rated on a 5-point scale, 1=not very dangerous to 5=very dangerous), which was also adapted to assess perception of harm of e-cigarette use.…”

Section: Methodsmentioning

confidence: 99%

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Impact of e-cigarette retail displays on attitudes to smoking and vaping in children: an online experimental study

et al. 2022

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ObjectivesTo estimate the impact of electronic cigarette (e-cigarette) retail display exposure on attitudes to smoking and vaping (susceptibility to tobacco smoking and using e-cigarettes, and perceptions of the harms of smoking and e-cigarette use).DesignBetween-subjects randomised experiment using a 2 (e-cigarette retail display visibility: high vs low)×2 (proportion of e-cigarette images: 75% vs 25%) factorial design.SettingOnline via the Qualtrics survey platform.ParticipantsUK children aged 13–17 years (n=1034), recruited through a research agency.InterventionParticipants viewed 12 images of retail displays that contained e-cigarette display images or unrelated product images. E-cigarette display images were either high or low visibility, based on a conspicuousness score. Participants were randomised to one of four groups, with e-cigarette display visibility and proportion of e-cigarette images, compared with images of unrelated products, manipulated: (1) 75% e-cigarettes, high visibility; (2) 25% e-cigarettes, high visibility; (3) 75% e-cigarettes, low visibility; (4) 25% e-cigarettes, low visibility.Main outcome measuresThe primary outcome was susceptibility to smoking (among never smokers only). Secondary outcomes were susceptibility to using e-cigarettes (among never vapers only), and perceptions of smoking and e-cigarette harm (all participants).ResultsNeither e-cigarette retail display visibility, nor the proportion of e-cigarette images displayed, appeared to influence susceptibility to smoking (visibility: OR=0.84, 95% CI 0.62 to 1.13, p=0.24; proportion: OR=1.34, 95% CI 1.00 to 1.82, p=0.054 (reference: low visibility, not susceptible)).Planned subgroup analyses indicated that exposure to a higher proportion of e-cigarette images increased susceptibility to smoking among children who visited retail stores more regularly (n=524, OR=1.59, 95% CI 1.04 to 2.43, p=0.034), and those who passed the attention check (n=880, OR=1.43, 95% CI 1.03 to 1.98, p=0.031).In addition, neither e-cigarette retail display visibility nor the proportion of e-cigarette images displayed, appeared to influence susceptibility to using e-cigarettes (visibility: OR=1.07, 95% CI 0.80 to 1.43, p=0.65; proportion: OR=1.22, 95% CI 0.91 to 1.64, p=0.18).Greater visibility of e-cigarette retail displays reduced perceived harm of smoking (mean difference (MD)=−0.19, 95% CI −0.34 to −0.04, p=0.016). There was no evidence that the proportion of e-cigarette images displayed had an effect (MD=−0.07, 95% CI −0.22 to 0.09, p=0.40).Perceived harm of e-cigarette use did not appear to be affected by e-cigarette retail display visibility (MD=−0.12, 95% CI −0.28 to 0.05, p=0.16) or by the proportion of e-cigarette images displayed (MD=−0.10, 95% CI −0.26 to 0.07, p=0.24).ConclusionsThere is no evidence in the full sample to suggest that children’s susceptibility to smoking is increased by exposure to higher visibility e-cigarette retail displays, or to a higher proportion of e-cigarette images. However, for regular store visitors or those paying more attention, viewing a higher proportion of e-cigarette images increased susceptibility to smoking. In addition, viewing higher visibility e-cigarette images reduced perceived harm of smoking. A review of the current regulatory discrepancy between tobacco and e-cigarette point-of-sale marketing is warranted.Trial registration numberISRCTN18215632.

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Section: Discussionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Impact of e-cigarette retail displays on attitudes to smoking and vaping in children: an online experimental study

et al. 2022

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“…After adjusting for all other variables in the model, these associations decreased or became non-significant. It is well established that exposure to product marketing is associated with reduced perceptions of tobacco’s danger that are, in turn, associated with product use 37–39. We therefore conducted a post hoc bootstrap mediation analysis to see whether there was an indirect effect of perceived frequent product marketing exposure (predictor) on class membership (outcome) via reduced danger perception (mediator).…”

Section: Resultsmentioning

confidence: 99%

Changes in patterns of youth multiple tobacco and/or e-cigarette product use in the US between 2014 and 2020: a multiple-group latent class analysis

et al. 2022

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BackgroundMultiple tobacco and e-cigarette product (MTEP) use, the concurrent use of two or more different types of tobacco and/or e-cigarettes products, is common among young people in the US. Changes in patterns of MTEP use among US youth between 2014 and 2020 were identified and the determinants of MTEP use were examined.MethodsFour years of repeated cross-sectional data from the US National Youth Tobacco Survey of middle and high school students from grade 6 to 12 (Ntotal=77 402). Multigroup latent class analysis (LCA) was applied to the data series to allow for simultaneous identification of MTEP use patterns between 2014 and 2020. Logistic regression was used to predict class membership on demographic and tobacco-related variables.FindingsOver the 7-year period, LCA identified three patterns: minimal/non-users (MNU: ~89.8%), mostly occasional e-cigarette and cigarette users (MOEC: ~9%) and polytobacco users (POLY: ~1.2%). From 2014 to 2020, MNU increased from 86.4% to 92% (p<0.05), while MOEC and POLY decreased from 11.2% to 7.9% and from 2.4% to 0.1%, respectively. The probability of regular e-cigarette use increased from 0 to 2.3% among MNU, 6% to 31.9% among MOEC and 29.6% to 67.6% among POLY (p<0.05). In binomial logistic regression, being male, in high school, non-heterosexual, living with someone who uses tobacco at home, having cognitive difficulties, having lower perceptions of tobacco’s danger and exposure to tobacco marketing were associated with greater odds of MOEC and POLY than MNU.ConclusionsThere was an increase in regular e-cigarette use in all three classes, but a corresponding decrease in the proportion of MTEP use. Public health interventions to discourage uptake of e-cigarettes, such as tighter restrictions on marketing to minors, are warranted and there is a need to consider disparities in the determinants of MTEP use.

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“…In this context, Vasiljevic and colleagues evaluated the impact of exposure to advertisements promoting e-cigarettes on appeal and susceptibility of tobacco smoking using an experimental design. They found no differences in appeal, susceptibility, or perceived harm of cigarette smoking between youth who were randomized to the exposure group and the control group 17 . Despite the lack of direct behavioral measures, this study suggests that the exposure to e-cigarette advertisement had no acute effect on the measures related to cigarette smoking.…”

Section: Introductionmentioning

confidence: 96%

E-cigarette use and onset of first cigarette smoking among adolescents: An empirical test of the ‘common liability’ theory

2020

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Background: E-cigarettes have become the most commonly used tobacco products among youth in the United States (US) recently. It is not clear whether there is a causal relationship between e-cigarette use and the onset of cigarette smoking. The “common liability” theory postulates that the association between e-cigarette use and cigarette smoking can be attributed to a common risk construct of using tobacco products. This study aims to investigate the relationship between ever e-cigarette use and cigarette smoking onset in the US using a structural equation modeling approach guided by the “common liability” theory. Methods: The study population is non-institutionalized civilian adolescents living in the US, sampled in the longitudinal Population Assessment of Tobacco and Health study. Information about tobacco product use was obtained via confidential self-report. A structural equation modeling approach was used to estimate the relationship between e-cigarette use at wave 1 and the onset of cigarette smoking at wave 2 after controlling for a latent construct representing a “common liability to use tobacco products.” Results: After controlling for a latent construct representing a “common liability to use tobacco products”, ever e-cigarette use does not predict the onset of cigarette smoking (β=0.13, 95% CI= -0.07, 0.32, p=0.204). The latent “common liability to use tobacco products” is a robust predictor for the onset of cigarette smoking (β=0.38; 95% CI=0.07, 0.69; p=0.015). Conclusions: Findings from this study provide supportive evidence for the ‘common liability’ underlying observed associations between e-cigarette use and smoking onset.

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E-cigarette adverts and children’s perceptions of tobacco smoking harms: an experimental study and meta-analysis

Cited by 12 publications

References 35 publications

Impact of e-cigarette retail displays on attitudes to smoking and vaping in children: an online experimental study

Impact of e-cigarette retail displays on attitudes to smoking and vaping in children: an online experimental study

Changes in patterns of youth multiple tobacco and/or e-cigarette product use in the US between 2014 and 2020: a multiple-group latent class analysis

E-cigarette use and onset of first cigarette smoking among adolescents: An empirical test of the ‘common liability’ theory

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