Associations of attitudes towards electronic cigarettes with advertisement exposure and social determinants: a cross sectional study
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College of Public Health, Kent State University, 800 E. Summit St, Kent 44240, OH, USA
Health Policy and Management, College of Public Health, Kent State University, 800 E. Summit St, Kent 44240, OH, USA
Deric R. Kenne   

College of Public Health, Kent State University, 800 E. Summit St, Kent 44240, OH, USA
Submission date: 2016-04-28
Acceptance date: 2017-02-08
Publication date: 2017-02-13
Tob. Induc. Dis. 2017;15(February):13
The exposure of young adults to electronic cigarette (e-cigarette) advertisements has risen rapidly. E-cigarette ads have been shown to increase short term perceived acceptability of using e-cigarettes in places where traditional cigarettes are banned. We set out to investigate if advertising exposure was related to perceptions of harm, addictiveness, and acceptability of use of e-cigarettes in places where traditional cigarettes are banned.

Using a cross-sectional design, 6037 students at a large Midwestern university between the ages of 18–24 were surveyed about e-cigarette use and smoking status. Bivariate analyses were performed associating perception of harm, addictiveness, and acceptability of e-cigarette use in places where smoking is banned with demographic and other background factors, and e-cigarette advertising exposure through different media channels. Logistic regression analyses were used to explore the relationship of these factors on perceptions of harm, addictiveness and acceptability of e-cigarette use in places where smoking is banned.

More than a quarter (27.4%) of respondents had used an e-cigarette, greater than half (53.2%) had seen an advertisement on TV and 42.0% had seen an advertisement on the Internet. Logistic regressions revealed that being white, male, an e-cigarette user, a smoker, having a mother who smoked, and Internet advertisement exposure were associated with lower perceived harm of e-cigarettes. The same factors, plus having seen advertisements on TV, were associated with increased likelihood of perceiving e-cigarette use in bars, stores, at work and in a dorm as acceptable. Perceiving use of e-cigarettes as acceptable in classrooms was also associated with the aforementioned factors and also included race. Only being male and an e-cigarette user were associated with lower perceived addictiveness of e-cigarettes.

E-cigarette use is increasing in adolescents and young adults, as is exposure to e-cigarette advertising. Independent of nicotine use and demographics factors, e-cigarette advertising is associated with increased beliefs in acceptability of e-cigarette use in places where cigarettes are banned. E-cigarette advertisements may be responsible for normalizing e-cigarette use. Exposure to internet e-cigarette advertisements was associated with lower perceived harm; this may be due to the false health claims often made in internet advertisements.

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