Advertising Influences E-cigarette Use Among Youth



Joe Camel and the Marlboro Man are long gone, but tobacco advertising still has a powerful effect on teenagers according to the Centers for Disease Control and Prevention (CDC). Specifically, researchers found a link between exposure to advertisements for e-cigarettes and their use by middle and high school students.

“Many of the ads we’re seeing for e-cigarettes today that rely on sex, independence, and rebellion look eerily like the ads that were used to sell cigarettes and other conventional tobacco products for generations,” said Brian King, PhD, deputy director for research translation in the CDC’s office on Smoking and Health.

The researchers assessed the youths’ use of e-cigarettes over the previous 30 days and their exposure to advertising in retail stores, on the internet, in television and movies, and in magazines and newspapers as part of the National Youth Tobacco Survey, conducted among more than 22,000 middle and high school students in 2014.

According to the study, the greater the exposure to these advertisements, the greater the students’ odds of e-cigarette use. The CDC also noted that spending on e-cigarette advertising rose from $6.4 million in 2011 to about $115 million in 2014.

E-cigarette use among youth also climbed during the same period, from 1.5% in 2011 to 13.4% in 2014 among high school students, as well as from 0.6% in 2001 to 3.9% in 2014 among middle school students. In 2014, e-cigarettes surpassed conventional cigarettes as the most commonly used tobacco product among youth.

And the numbers keep rising. In 2014, 2.46 million students used e-cigarettes. In 2015, the total was 3 million. That’s 16% of high school and 5.3% of middle school students, making e-cigarettes the most commonly used tobacco product among youth for the second consecutive year.

“Kids should not use any type of product, including e-cigarettes,” said CDC director Tom Frieden, MD, MPH. “Exposure to e-cigarette advertising is associated with youth e-cigarette use, and that is concerning to me as CDC director, as a doctor, and as a parent.”

“Any tobacco use by youth is dangerous to their health,” said King. “The unrestricted marketing of e-cigarettes and dramatic increases in their use by youth could reverse decades of progress in preventing tobacco use among youth.”

The Food and Drug Administration (FDA) has regulatory authority over cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco. It is now developing a rule that, if finalized as proposed, would bring additional tobacco products such as e-cigarettes, hookahs, and some or all cigars under that same authority.

“Finalizing the rule to bring additional products under the agency’s tobacco authority is one of our highest priorities, and we look forward to a day in the near future when such products are properly regulated and reasonably marketed,” said Mitch Zeller, director of the FDA’s Center for Tobacco Products.

Currently, the FDA is expanding its expanding its “The Real Cost” public awareness campaign to educate rural, white male teenagers about the dangers of smokeless tobacco use, which include nicotine addiction, gum disease, tooth loss, and multiple kinds of cancer, through advertisements in 35 handpicked markets in the United States.

“In communities where smokeless tobacco use is part of the culture, reaching at-risk teens with compelling messaging is critical to help change their understanding of the risks and harms associated with smokeless tobacco use,” said Zeller.

The FDA reports that about 629,000 or 31.84% of rural, white males between the ages of 12 and 17 are experimenting with or at risk of using smokeless tobacco. Also, the Substance Abuse and Mental Health Services Administration says that nearly 1,000 males under the age of 18 use smokeless tobacco for the first time each day.

Furthermore, the CDC has found that overall tobacco use by middle and high school students has not changed since 2011. According to the agency, 4.7 million middle and high school students had used a tobacco product at least once in the previous 30 days in 2015, and more than 2.3 million of those students used 2 or more tobacco products.

“We’re very concerned that one in 4 high school students use tobacco and that almost half of those use more than one product,” said Corinne Graffunder, DrPH, director of the CDC’s Office on Smoking and Health. “Fully implementing proven tobacco strategies could prevent another generation of Americans from suffering from tobacco-related diseases and premature deaths.”

Oral Health America (OHA) notes that consumers under the age of 21 only account for 2.12% of total tobacco sales. Yet 90% of smokers start by the age of 21, so these sales lead to 9 out of every 10 new smokers. OHA’s Tobacco 21 campaign aims to raise the smoking age to 21 at municipal, state, and national levels to decrease youth smoking totals.

“No form of tobacco use is safe,” said Frieden. “Nicotine is an addictive drug and use during adolescence may cause lasting harm to brain development.”

The CDC encourages states and localities to limit tobacco product sales to facilities that never admit youth; restrict the number of stores that sell tobacco products as well as how close they can be to schools; and limit internet sales of e-cigarettes and other tobacco products.

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