The association of adolescent e-cigarette harm perception to advertising exposure and marketing type

• Type of Material: Article
• Authors: Man Hung, Roseman University of Health Sciences; Andrew Spencer, Emory University; Clarissa Goh, Riverton High School; Eric S Hon, The College, University of Chicago; Val Joseph Cheever, Roseman University of Health Sciences; Frank W Licari, Roseman University of Health Sciences; Ryan Moffat, Roseman University of Health Sciences; Ben Raymond, Roseman University of Health Sciences; Martin S Lipsky, Roseman University of Health Sciences
• Language: English
• Date: 2022-12-01
• Publisher: BioMed Central Ltd
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s13690-022-00867-6
• Title of Journal or Parent Work: Archives of Public Health
• Volume: 80
• Issue: 1
• Grant/Funding Information: This study was supported by Roseman University College of Dental Medicine Clinical Outcomes Research and Education, and the Summer Program for Undergraduate Research at the University of Utah.
• Keywords: Newspaper; Harm perceptions; Marketing; Social media; e-cigarette; Adolescents; Health
• Research Categories: Psychology, General

Abstract

Background: Despite controversy over their possible health consequences, manufacturers of e-cigarettes employ a variety of marketing media to increase their popularity among adolescents. This study analyzed the relationship between adolescent e-cigarette harm perception and five types of e-cigarette advertising exposures: social media, radio, billboard, newspaper, and television. Methods: This study used data from Wave 4.5 of the Population Assessment of Tobacco and Health Study (PATH). PATH collects demographic data and interview individuals about issues pertaining to tobacco use, health outcomes, attitudes, and behaviors. This study applied factor analysis to three individual PATH harm perception items to develop a composite harm perception score. Using linear regression, the study explored the relationship of harm perception and participant responses to their recalled viewing of five different types (i.e., newspaper, radio, billboard, television and social media) of advertisements within the past 30 days. A second analysis explored if adjusting for exposure to anti-tobacco messaging and environmental factors such as family approval mitigated the association of harm perception and advertisement types. Results: The study sample consisted of 12,570 (weighted N = 23,993,149) individuals aged 12 to 17 years old. Unadjusted past 30-day exposure to newspaper, radio, billboard, and social media advertising all correlated with a reduced harm perception, but only the associations for newspaper and social media were statistically significant (p<0.05). After adjusting for environmental support factors, exposure to warning labels, and anti-tobacco advertisements, the analysis yielded statistically significant associations between increased e-cigarette harm perception and exposure to radio, billboard, and television advertisements (p<0.05). Adjusting for covariates also reduced the association of marketing and harm perception for all forms of media. Conclusion: E-cigarette advertising influences adolescent perceptions of harm in e-cigarette use, particularly for social media and newspaper advertisements. This association weakens when adjusted for covariates such as environmental support and exposure to anti-tobacco marketing. These findings provide evidence for policy makers to continue anti-tobacco marketing and incorporate environmentally supportive strategies such as holistic, family-centered educational approaches to reduce e-cigarette use among adolescents.