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
Publish 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.

1. United States Department of Health and Human Services: The Health Consequences of Smoking—50 Years of Progress A Report of the Surgeon General. A Rep Surg Gen 2014:1081.
2. Nutt D, King LA, Saulsbury W, Blakemore C. Development of a rational scale to assess the harm of drugs of potential misuse. Lancet. 2016;369:1047–53.
3. Miech RA, Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future national survey results on drug use, 1975-2014: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan; 2015. p. 599.
4. Grana R, Benowitz N, Glantz SA. E-cigarettes: a scientific review. Circulation. 2014;129(19):1972–86.
5. Fairchild A, Bayer R, Colgrove J. The renormalization of smoking? E-cigarettes and the tobacco “endgame”. N Engl J Med. 2014;370(4):293–5.
6. Dutra LM, Glantz SA. High international electronic cigarette use among never smoker adolescents. J Adolesc Health. 2014;55:595–7.
7. Allen JG, Flanigan SS, Leblanc M, Vallarino J, Macnaughton P, Stewart JH, Christiani DC. Flavoring chemicals in e-cigarettes: diacetyl, 2,3-pentanedione, and acetoin in a sample of 51 products, including fruit-, candy-, and cocktail-flavored e-cigarettes. Environ Health Perspect. 2016;124:733–9.
8. U.S. Department of Health & Human Services. Deeming tobacco products to be subject to the federal food, drug, and cosmetic act, as amended by the family smoking prevention and control act. Fed Regist. 2016;80:1–195.
9. Duke JC, Lee YO, Kim AE, Watson KA, Arnold KY, Nonnemaker JM, Porter L. Exposure to electronic cigarette television advertisements among youth and young adults. Pediatrics. 2014;134:e29–36.
10. Cobb NK, Brookover J, Cobb CO. Forensic analysis of online marketing for electronic nicotine delivery systems. Tob Control. 2015;24:128–31.
11. Link AR, Cawkwell PB, Shelley DR, Sherman SE. An exploration of online behaviors and social media use among hookah and electronic-cigarette users. Addict Behav Rep. 2015;2:37–40.
12. Farrelly MC, Duke JC, Crankshaw EC, Eggers ME, Lee YO, Nonnemaker JM, Kim AE, Porter L. A randomized trial of the effect of E-cigarette TV advertisements on intentions to use E-cigarettes. Am J Prev Med. 2016;49:686–93.
13. SAS. SAS/STAT 9.3 User’s guide. User’s guide. Cary: SAS Institute Inc; 2011. p. 8640.
14. De Vries H, Engels R, Kremers S, Wetzels J, Mudde A. Parents’ and friends’ smoking status as predictors of smoking onset: findings from six European countries. Health Educ Res. 2003;18:627–36.
15. Lynn P. Weighting for Non-Response. Surv Stat Comput 1996.
16. Primack BA, Soneji S, Stoolmiller M, Fine MJ, Sargent JD. Progression to traditional cigarette smoking after electronic cigarette use among US adolescents and young adults. JAMA Pediatr. 2015;169:1018–23.
17. Pearson JL, Richardson A, Niaura RS, Vallone DM, Abrams DB. e-cigarette awareness, use, and harm perceptions in US adults. Am J Public Health. 2012;102:1758–66.
18. Ma GX, Shive S, Legos P, Tan Y. Ethnic differences in adolescent smoking behaviors, sources of tobacco, knowledge and attitudes toward restriction policies. Addict Behav. 2003;28:249–68.
19. Berg CJ, Lessard L, Parelkar PP, Thrasher J, Kegler MC, Escoffery C, Goldade K, Ahluwalia JS. College student reactions to smoking bans in public, on campus and at home. Health Educ Res. 2011;26:106–18.
20. Berg CJ, Stratton E, Schauer GL, Lewis M, Wang Y, Windle M, Kegler M. Perceived harm, addictiveness, and social acceptability of tobacco products and marijuana among young adults: marijuana, hookah, and electronic cigarettes win. Subst Use Misuse. 2015;50:79–89.
21. Halpern-Felsher BL, Biehl M, Kropp RY, Rubinstein ML. Perceived risks and benefits of smoking: differences among adolescents with different smoking experiences and intentions. Prev Med (Baltim). 2004;39:559–67.
22. Groves RM. Nonresponse rates and nonresponse bias in household surveys. Public Opin Q. 2006;70:646–75.
23. Massey DS, Tourangeau R. Where do We Go from here? nonresponse and social measurement. Ann Am Acad Pol Soc Sci. 2013;645:222–36.
24. Peytchev A. Consequences of survey nonresponse. Ann Am Acad Pol Soc Sci. 2013;645:88–111.
25. Couper MP. The promises and perils of web surveys. In: Westlake A, Sykes W, Manners T, Rigg M, editors. In the challenge of the internet. Proceedings of the ASC international conference on survey research methods. London: Association for Survey Computing; 2001. p. 35.
26. McCabe SE. Gender differences in collegiate risk factors for heavy episodic drinking. J Stud Alcohol. 2002;63:49–56.
27. Deutskens E, de Ruyter K, Wetzels M, Oosterveld P. Response rate and response quality of internet-based surveys: an experimental study. Mark Lett. 2004;15:21–36.
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