Ethnicity and the mechanisms of point-of-sale e-cigarette marketing’s influence on behavior: A longitudinal study.

Abstract

Objective: To test the mechanisms by which exposure to point-of-sale (POS) e-cigarette marketing mediate the relationship between an ethnic minority group highly vulnerable for tobacco product use, namely Native Hawaiian/Other Pacific Islander (NHPI), and increased future e-cigarette use through explicit (positive outcome expectancies) and implicit (spontaneous positive reactions) pathways. Method: Four waves of data were collected in 6-month intervals from 2,327 multiethnic young adults (M age = 21.2, SD = 2.2; 54% women) enrolled across two 4-year and four 2-year colleges belonging to a University system in Hawaii. POS e-cigarette marketing exposure was assessed with an objective measure involving store visit patterns and store audits, as well as a measure of self-reported exposure. Spontaneous reactions were assessed with an implicit measure, namely Affect Misattribution Procedure (AMP). Path analyses were used to test the hypotheses. Results: In a model employing the objective measure of POS exposure, a statistically significant pathway was found from NHPI ethnicity to increased current e-cigarette use at Wave 4 mediated through increased POS exposure at Wave 2, and increased affect regulation expectancies at Wave 3. Similar indirect effects on prospective e-cigarette use were found for Asian ethnicity. The dual process model of the effects of POS exposure on e-cigarette use was not fully supported, although the implicit measure was found to independently predict e-cigarette use. Conclusions: Differential exposure to POS marketing may explain some of the ethnic disparities in tobacco product use behavior such as e-cigarette use. POS marketing may affect e-cigarette use behavior mainly through the explicit pathway, notably affect regulation expectancies. Public Health Significance StatementThis research, based on multi-ethnic young adults from Hawaii, showed how Native Hawaiian/Pacific Islanders who, as a group, face high levels of tobacco-related morbidity and mortality, are more likely to be exposed to point-of-sale e-cigarette marketing compared with other groups such as Asian or White. In addition, this research highlighted how POS marketing may influence young adults to use e-cigarettes by appealing to the beliefs that e-cigarette use makes one feel better or relaxed. These findings may be used to regulate POS marketing or develop counter-marketing strategies that may help reduce health disparities and prevent e-cigarette use among young people.

Ethnic differences in respiratory disease for Native Hawaiians and Pacific Islanders: Analysis of mediation processes in two community samples

“…We expected that Pacific Islanders and Filipinos could share some exposures but did not frame specific hypotheses because of a lack of epidemiological data on these groups. After characterizing ethnic differences in respiratory disease prevalence, we performed mediation analyses [ 29 , 30 ] to test for the significance of pathways linking ethnic-group membership to risk-factor exposures and likelihood of respiratory disorder. Results from initial mediation tests with a 2016 survey were tested for replicability with data from a 2018 survey to determine whether observed indirect and direct effects for ethnicity would be replicated across two independent studies.…”

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

“…Social network e‐cigarette use was tested as a time‐varying covariate because social network characteristics tend to change over time. E‐cigarette use in social networks is known to explain a large proportion of variance in e‐cigarette use [29] and may be associated with e‐cigarette advertising exposure [30].…”

“…Thus, the present study employed four waves of data from a sample of multi-ethnic young adults from Hawaii to examine the inter-relationships among trajectories of e-cigarette advertising exposure, e-cigarette use, and cigarette smoking over a period of approximately two years. Specifically, the study used latent growth curve (LGC) analysis to determine: works is known to explain a large proportion of variance in e-cigarette use [29] and may be associated with e-cigarette advertising exposure [30].…”