Quantifying Cigarette and e-Cigarette Marketing Exposure Among Chinese Adolescents Using Ecological Momentary Assessment

Abstract

Introduction Addressing cigarette and e-cigarette use in China is key to reducing the global tobacco epidemic. Marketing exposure is one causal factor for adolescent smoking and e-cigarette use. Currently, China restricts cigarette and e-cigarette ads in public places and online; however, there may not be full policy compliance. We collected real-time data in the natural environment to estimate how much and where Chinese adolescents – a group susceptible to smoking and e-cigarette use – are exposed to cigarette and e-cigarette marketing to inform policy responses. Methods In June 2022, we conducted a seven-day ecological momentary assessment (EMA) study with 15-16-year-olds (n=96) across eight Chinese cities. Participants completed up to 42 EMA surveys (6 per day), sent at random intervals outside of school hours. In each survey, participants reported whether they saw (1) displays and (2) ads in the past hour (none, cigarette, e-cigarette, both) in the past hour. We also captured the source of cigarette/e-cigarette ad exposure. Results Most participants were exposed to cigarette and/or e-cigarette displays (89.6%) or ads (79.2%) over the seven days. On average, participants reported past-hour exposure to displays 12.7 times and past-hour exposure to ads 10.8 times over the week. The most common sources of cigarette ads were public places (e.g., kiosks, supermarkets); the most common sources of e-cigarette ad exposure were social media/internet or e-cigarette stores. Conclusions Findings highlight the need to enhance enforcement of restrictions on cigarette and e-cigarette ads in public places and online in China and extend restrictions to ban displays. IMPLICATIONS Marketing exposure is a causal factor in youth smoking and e-cigarette use. We used ecological momentary assessments to estimate cigarette and e-cigarette display and ad exposure among Chinese adolescents. On average, participants reported past-hour exposure to cigarette and/or e-cigarette displays 13 times and past-hour exposure to cigarette and/or e-cigarette ads 11 times over one week. Most saw ads in public places and online. Results suggest strengthening implementation of China’s ban on cigarette and e-cigarette ads in public places and online and banning product displays. These are policy responses that can contribute to reducing adolescent cigarette and e-cigarette uptake in China.