How the Other Half Sees It: E-cigarette Advertising Exposure and Subsequent E-cigarette Use Among U.S. Young Adult Cigarette Smokers

Abstract

INTRODUCTION E-cigarette advertising may benefit young adult cigarette smokers in transitioning to using e-cigarettes. We assessed whether e-cigarette advertising exposure was associated with subsequent e-cigarette use among young adult cigarette smokers. METHODS Data were from Waves 4 (2016–2018) and 5 (2018–2019) of the nationally-representative Population Assessment of Tobacco and Health (PATH) Study adult survey. Respondents were young adult established cigarette smokers at Wave 4 (18–34 years; n=3,391) and a sub-sample of those who tried to quit smoking cigarettes completely in the past year at Wave 5 (n=1,235). Multivariable logistic regressions were used to examine the associations between e-cigarette advertising exposure (by channel of exposure) and subsequent past-year e-cigarette use in general and e-cigarette use to quit smoking cigarettes, controlling for covariates. RESULTS At Wave 5, 43.4% of smokers reported past-year use of e-cigarettes; and 14.8% of smokers who tried to completely quit smoking reported past-year use of e-cigarettes to quit. E-cigarette advertising exposure was associated with subsequent past-year e-cigarette use (AOR=1.53, p<0.0001, 95% CI=1.27, 1.86) and past-year use to quit smoking cigarettes (AOR=1.65, p<0.01, 95% CI=1.19, 2.29). Advertising exposure through brick-and-mortar stores or websites/social media was similarly associated with both e-cigarette use behaviors. DISCUSSION Exposure to e-cigarette advertising among U.S. young adult established cigarette smokers may be associated with subsequent e-cigarette use and use to quit smoking. More research is needed to understand the features of e-cigarette advertising (e.g., discounts, flavors, smoker-targeted claims) that may shape perception and behavior related to e-cigarette use among young adult smokers. Implications Little is known about the associations between e-cigarette advertising exposure and e-cigarette use among young adult cigarette smokers who may benefit from switching to e-cigarettes. This study found that e-cigarette advertising exposure was positively associated with (1) subsequent e-cigarette use among U.S. young adult established cigarette smokers and (2) subsequent e-cigarette use to quit smoking cigarettes among those who tried to completely quit in the past year. These observed associations were driven by smokers who did not currently use e-cigarettes at baseline. E-cigarette advertising exposure through brick-and-mortar stores or websites/social media was also positively associated with subsequent e-cigarette use behaviors.

Associations between e-cigarette marketing exposure and vaping nicotine and cannabis among U.S. adults, 2021

“…With the continued rise in cannabis vaping prevalence among young adults in the country, 2 more research is needed to investigate the role of e-cigarette marketing, and more directly cannabis vape product marketing, on cannabis vaping behaviors among this population. For example, it may be important to examine the influence of specific marketing features (e.g., flavor descriptions, price promotions, human models, health claims, warnings) [46][47][48][49] on cannabis vape product use perceptions and behaviors among young adults.…”

“…16 To minimize missing data, we used imputed demographic variables and derived tobacco use variables included in the PATH public use data files and included an "undetermined" category for variables with missing values larger than 5% of the sample. 4,5,7 For regression models, we used listwise deletion since missing data were minimal across variables used for analysis (<0.5%). 24 Adjusted risk ratios (aRR) and 95% CIs were reported in regression analyses.…”

“…At Wave 6, respondents were asked: “In the past 30 days, have you noticed e-cigarettes or other electronic nicotine products being advertised in any of the following places?” (“Yes” and “No” options were displayed for each of the following channels): “Gas stations, convenience stores, or other retail stores,” “On billboards,” “In newspapers or magazines,” “On radio,” “On television,” “At events like fairs, festivals, or sporting events,” “At nightclubs, bars, or music concerts,” “In email messages,” “On social media,” “On other websites online,” and “Somewhere else.” We created an overall binary variable that indicated any e-cigarette marketing exposure via any channel versus no exposure as well as ten variables based on e-cigarette marketing exposure versus no exposure via each channel. 4,5,7…”

“…We created an overall binary variable that indicated any e-cigarette marketing exposure via any channel versus no exposure as well as ten variables based on e-cigarette marketing exposure versus no exposure via each channel. 4,5,7 Past 30-Day Vaping Behavior…”

Using Eye tracking to Examine Young Adults’ Visual Attention to E-cigarette Advertising Features and Associated Positive E-cigarette Perceptions

“…E-cigarette marketing plays an important role in shaping the perceptions and use intentions of e-cigarette products among young adults with varying tobacco-use behaviors [ 8–11 ]. For example, e-cigarette marketing exposure is associated with subsequent e-cigarette use among both young adults naïve to tobacco products and young adults with established cigarette smoking behaviors [ 9 , 11 ]. For young adults who smoke cigarettes, e-cigarette marketing exposure was also associated with subsequent e-cigarette use to quit smoking cigarettes [ 11 ].…”