E-cigarettes have become the most popular nicotine product among young people, with evidence that they are heavily marketed to youth and young adults. Yet, the marketing of e-cigarettes remains unregulated, and the impact of such marketing on young people’s e-cigarette use is not fully understood. For a study published in Pediatrics, our research team examined the impact of e-cigarette marketing on subsequent e-cigarette initiation among two large cohorts of youth (aged 12-17 in 2014) and young adults (aged 18-29 in 2014). We selected only those youth (n=2,288) and young adults (n=2,423) who had never used e-cigarettes at the beginning of the study in fall 2014.

We asked the e-cigarette naïve participants if they saw advertising and promotions for e-cigarettes via five media channels, including TV, radio/internet radio, billboards, the internet, and in retail stores. The impact of reported exposure to e-cigarette marketing across these channels on subsequent e-cigarette initiation up to 2.5 years later was then analyzed, with adjustments for well-known correlates of tobacco marketing and tobacco use, including sensation seeking, peer e-cigarette use, and the use of other tobacco products. Our team found that e-cigarette-naïve youth and young adults were more likely to report seeing e-cigarette marketing at retail stores than on any other channels and that recalled exposure to e-cigarette marketing at retail stores increased risk for e-cigarette initiation among both youth (adjusted odds ratio [aOR] = 1.99; 95% confidence interval [CI]: 1.25–3.17) and young adults (aOR = 1.30; 95% CI: 1.05–1.61). Recalled exposure to e-cigarette marketing on TV among young adults was the only other predictor of e-cigarette initiation (aOR = 1.29; 95% CI: 1.03–1.63).

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These findings underscore the need for physicians to talk to patients and their families about the role of marketing on e-cigarette use. Physicians can also educate patients about the potential harms associated with e-cigarette use, particularly exposure to nicotine. The developing brains of youth and young adults are especially vulnerable to nicotine, and long-term use may result in addiction as well as problems with impulse control, mood regulation, attention, and learning.