E-cigarettes are enticing enough to young people with their fruit flavors and slick smoking devices, but new research suggests that marketing in retail stores may also encourage some teenagers to take up vaping.
Researchers found that teens who recalled seeing in-store marketing were twice as likely to start vaping over the next couple years. A similar pattern, though not as strong, was seen among college-age adults.
It's no secret that young Americans are surrounded by e-cigarette marketing. In 2014, 7 out of 10 middle and high school students were exposed to it, according to the U.S. Centers for Disease Control and Prevention.
The marketing is pervasive -- in stores, online, in magazines and on TV. But not much is known about how kids and young adults respond to it.
The new study, published Aug. 26 in the journal Pediatrics, suggests in-store marketing is particularly influential.
It makes sense, since the e-cigarettes are right there to buy, said Stanton Glantz, a professor of tobacco control at the University of California, San Francisco.
Glantz, who was not involved in the study, said it was "well-done" and, like tobacco companies' own research, points to the power of marketing.
With in-store marketing, companies pay to get "high visibility" product placement, Glantz said. They also offer coupons and other price promotions.
Advertising for traditional tobacco products is no longer allowed on TV and radio. But tobacco companies still spend about $9 billion a year on in-store marketing, according to the Campaign for Tobacco-Free Kids.
E-cigarettes, meanwhile, are subject to few advertising regulations -- though ads and the products themselves must feature a warning about the addictiveness of nicotine.
In the new study, researchers surveyed nearly 2,300 middle school and high school students, and more than 2,400 college students, about their exposure to e-cigarette marketing. They were asked to recall how often they saw promotions on TV, billboards, radio, online and in stores.
At the outset, none of the students were e-cigarette users. Two years later, though, 14 percent of teens and one-quarter of young adults had taken up vaping. The odds were twice as high among teenagers who'd seen in-store ads, versus their peers who hadn't.
Among young adults, those who'd seen such ads were 30 percent more likely to start vaping.
It is possible that some young people are just prone to noticing that type of marketing, and it's not the reason they started vaping, according to lead researcher Alexandra Loukas.
But, she said, her team did account for other key factors -- such as having friends who vaped, or a general tendency toward "sensation-seeking."
Even then, exposure to in-store marketing was tied to a higher likelihood of vaping.
"It might not be the most important predictor, but it does seem to be a factor," said Loukas, a professor at the University of Texas at Austin.
Was it surprising that internet marketing showed no special influence? Yes, Loukas said. However, she pointed out, students were surveyed in 2014 -- before the rise of the brand Juul and its use of social media promotion.
Juul has been blamed for a recent surge in vaping among U.S. teenagers. In 2018, more than 3.6 million middle and high school students were current e-cigarette users, according to the U.S. Food and Drug Administration. That was up by 78 percent from just the prior year among high school kids, and by 48 percent among middle school students.
"Juul has been especially successful in leveraging social media channels frequented by youth," said Pat Aussem, director of clinical content and development at the Center on Addiction, in New York City.
E-cigarette companies, she said, want "lifetime consumers," so they use marketing tactics right out of "Big Tobacco's playbook." That includes celebrity endorsements, cartoon characters and images of rebellion, Aussem said.
The problem is vaping is not benign. Nicotine is not only addictive, but affects the developing brain, Aussem said. And when people inhale e-cigarette aerosol, they are drawing toxins and fine particles into their lungs.
According to Loukas, there are steps regulators can take. The FDA has the authority to restrict the visibility of in-store e-cigarette marketing, for instance. And, she said, state and local governments can restrict price promotions for the products.
San Francisco recently went further, Glantz noted. Last month, it banned e-cigarette sales in the city.
The U.S. Food and Drug Administration has more on e-cigarettes and kids' health.
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