Receptivity to e-cigarette ads among young adults in the US leads to cigarette smoking

March 26, 2018, University of California - San Diego
Credit: CC0 Public Domain

Receptivity to advertising for e-cigarettes, cigarettes and cigars were confirmed to be associated with those who would try the respective tobacco product within one year. However, receptivity to e-cigarette advertising also independently increased the odds that 12- to 21-year-olds who have never smoked would try cigarette smoking within the next year by 60 percent. This finding, publishing in the March 26 issue of JAMA Pediatrics, was independent of receptivity to cigarette advertising.

Led by researchers at University of California San Diego Moores Cancer Center and Dartmouth-Hitchcock Norris Cotton Cancer Center, the team analyzed data from the U.S. Population Assessment of Tobacco and Health (PATH) Study and found that 12- to 24-year-olds who have never used products experienced high recall and/or liking, described as , of tobacco product (including e-cigarettes). Receptivity was highest for e-cigarette advertising, followed by ads for cigarettes, and lastly cigars. Recall and/or liking increased with age, peaking at 69 percent among 18 to 21 year olds.

Receptivity to a particular product's advertising predicted who would try that product within one year, said John P. Pierce, PhD, Professor Emeritus of Cancer Prevention at UC San Diego School of Medicine and Moores Cancer Center.

"This is the most comprehensive assessment to date of young people's receptivity to tobacco industry advertising," said Pierce, the lead author on the study. "There is a growing body of evidence that adolescents who start with an e-cigarette may transition to cigarettes. This study provides the first evidence that e-cigarette advertising is one of the risk factors for those who are underage to become cigarette smokers."

The study collected 959 tobacco advertising images that were used commercially in the year prior to the initial survey and a random sample of 20 of these images (five for each of cigarettes, e-cigarettes, cigars and smokeless ) were shown to study participants, aged 12 to 24 who reported having never used any type of tobacco product. Participants were considered receptive to a product's advertising if they recalled and/or liked any of the five images for that product. The study included a representative sample of 10,989 never in the initial assessment (2013-14) and were interviewed again one year later.

"Recognizing and liking tobacco advertising predicts which lowest risk adolescents will become future consumers of these products, after accounting for a number of traditional risk factors like peer and family smoking," said James Sargent, MD, professor of pediatrics at the Geisel School of Medicine and Norris Cotton Cancer Center at Dartmouth and a lead author. "This suggests that it may be something about the ads, not just the adolescents, which is driving them to try tobacco for the first time."

Young adults at lowest risk of becoming tobacco users were identified from among individuals who reported never using tobacco by their responses to three questions about each product. The questions assessed their curiosity about the product, intention to try it in the near future, and whether they would accept an offer of the product from a best friend. Only those with the strongest rejection to all three questions were categorized as "committed never users." All others were considered susceptible to use. The study confirmed that committed never tobacco users who were receptive to a product's advertising were significantly more likely to try using that product in the following year.

Among 12- to 21-year-old never tobacco users, receptivity to e-cigarette advertising, but not cigarette advertising, at the initial study questionnaire was associated with 4.9 percent of them (an estimated 224,446 never smokers) trying smoking within a year. Only 2.6 percent of those who were not receptive to any advertising tried smoking. This is a significant difference in the odds of starting to smoke cigarettes by 60 percent (i.e. adjusted odds ratio of 1.6). This rate was similar among those who were receptive to cigarette advertising but not e-cigarette advertising. In this group, 5.9 percent tried smoking within one year.

"Years ago, when we took away marketing of Joe Camel and similar ads, we saw a major decline in cigarette use among youth," said Pierce. "Today, these results suggest that it may be possible for the tobacco industry to use e-cigarette advertising as a way around the public health restrictions on cigarette advertising. E- is allowed on television and we now have evidence that these ads not only are an influence on committed never users to try an e-cigarette, but also an influence on never users under the age of 21 to start smoking cigarettes. There is an urgent need for more research to confirm this finding and determine why advertisements appear so effective at promoting cigarette smoking."

Explore further: National study looks at tobacco advertising and susceptibility to use tobacco among youth

More information: JAMA Pediatrics (2018). DOI: 10.1001/jamapediatrics.2017.5756

Related Stories

National study looks at tobacco advertising and susceptibility to use tobacco among youth

May 22, 2017
Among 12- to 17-year-olds who have never used tobacco products, nearly half were considered receptive to tobacco marketing if they were able to recall or liked at least one advertisement, report a coalition of behavioral ...

Non-cigarette tobacco use tied to future cigarette use in teens

January 4, 2018
(HealthDay)—Non-cigarette tobacco use is associated with subsequent cigarette smoking among U.S. adolescents, according to a study published online Jan. 2 in JAMA Pediatrics.

Higher cigarette taxes may increase use of chewing tobacco and cigars in adolescents

February 14, 2018
Raising cigarette taxes to combat smoking may increase the use of cigars and smokeless tobacco, such as chewing tobacco, in adolescents according to a study published in the open access journal BMC Public Health, involving ...

New study assesses the impact of exposure to e-cigarette ads on young adults

November 19, 2015
Exposure to e-cigarette advertisements may enhance curiosity and usage among young adults, according to a study published this week in the journal Nicotine & Tobacco Research.

E-cigarettes are more likely to be used by alcohol drinkers and former cigarette smokers

November 14, 2017
Electronic cigarettes are more frequently used by people who recently quit smoking and alcohol drinkers, according to preliminary research presented at the American Heart Association's Scientific Sessions 2017, a premier ...

In US, one in five use tobacco

November 9, 2017
One in five adults in the United States uses tobacco on a regular basis, and 15 percent of the population smokes cigarettes, according to US government data released Thursday.

Recommended for you

Teens get more sleep with later school start time, researchers find

December 12, 2018
When Seattle Public Schools announced that it would reorganize school start times across the district for the fall of 2016, the massive undertaking took more than a year to deploy. Elementary schools started earlier, while ...

Large restaurant portions a global problem, study finds

December 12, 2018
A new multi-country study finds that large, high-calorie portion sizes in fast food and full service restaurants is not a problem unique to the United States. An international team of researchers found that 94 percent of ...

Receiving genetic information can change risk

December 11, 2018
Millions of people in the United States alone have submitted their DNA for analysis and received information that not only predicts their risk for disease but, it turns out, in some cases might also have influenced that risk, ...

Yes please to yoghurt and cheese: The new improved Mediterranean diet

December 11, 2018
Thousands of Australians can take heart as new research from the University of South Australia shows a dairy-enhanced Mediterranean diet will significantly increase health outcomes for those at risk of cardiovascular disease ...

Effect of oral alfacalcidol on clinical outcomes in patients without secondary hyperparathyroidism

December 11, 2018
Treatment with active vitamin D did not decrease cardiovascular events in kidney patients undergoing hemodialysis, according to a research group in Japan. They have reported their research results in the December 11 issue ...

Licence to Swill: James Bond's drinking over six decades

December 10, 2018
He may be licensed to kill but fictional British secret service agent James Bond has a severe alcohol use disorder, according to an analysis of his drinking behaviour published in the Medical Journal of Australia's Christmas ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.