Coupons, samples, branded hats and T-shirts: When teens use or wear promotional items from companies that make alternative tobacco products like electronic cigarettes, they are more likely to try those products, new research shows.
The study included 757 California teens, aged 13 to 19, who were followed for a year. At the beginning of the year, none of them had ever used alternative tobacco products such as e-cigarettes, chewing tobacco, cigars, cigarillos, pipes and hookahs.
However, 81 owned items that promoted tobacco products, including 52 who owned promotional items for e-cigarettes.
During the next year, 129 participants (17 percent) started using alternative tobacco products but not traditional cigarettes, and 12 began using traditional cigarettes alone or in combination with alternative tobacco products, the findings showed.
Before adjusting for other factors, the researchers found that teens who owned promotional items were 2.3 times more likely to try alternative tobacco products than those who did not.
After adjusting for age, gender, race/ethnicity, maternal education level and baseline alcohol and cigarette use, teens who owned promotional materials were 2.1 times more likely to begin using alternative tobacco products.
Among teens who tried both alternative tobacco products and cigarettes, the influence of owning promotional materials was not statistically significant, the researchers said.
The findings were published online Friday in JAMA Network Open.
"The increase in use of alternative tobacco products poses a threat to the decades of hard work that public health experts have done to reduce tobacco use," study author Hoda Magid said. She is a postdoctoral scholar in health research and policy at Stanford University's School of Medicine.
These findings suggest that no tobacco company -- including e-cigarette makers -- should be allowed to give marketing materials to teens, and that the U.S. Food and Drug Administration should further restrict such marketing techniques, senior study author Bonnie Halpern-Felsher said in a university news release. Halpern-Felsher is a professor of pediatrics at Stanford.
Magid added that "manufacturers say they're not marketing to teens, but teens are reporting owning these promotional items, and they're reporting use of alternative tobacco products."
So while the study cannot prove a cause-and-effect relationship, the results "provide evidence that ownership of marketing materials is strongly associated with more young people using e-cigarettes and other alternative tobacco products," the researchers said in the news release.
The U.S. Centers for Disease Control and Prevention outlines the risks of e-cigarettes to young people.
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