July 8, 2015

Stanton A. Glantz, PhD

Direct evidence that e-cig TV ads are recruiting kids to nicotine addiction

Mattlhew Farrelly and colleagues at RTI just published an excellent experimental study demonstrating that e-cigarette TV ads being run by blu, NJOY, and 21st Century e-cigarette companies move youth who have never used e-cigarettes toward taking them up.  Here is the abstract of their paper, "A Randomized Trial of the Effect of E-cigarette TV Advertisements on Intentions to Use E-cigarettes," in American Journal of Preventive Medicine. 

Introduction: Adolescents’ use of electronic cigarettes (e-cigarettes) and exposure to e-cigarette TV advertising have increased in recent years, despite questions about their safety. The current study tests whether exposure to e-cigarette TV advertisements influences intentions to use e-cigarettes in the future and related attitudes.
Methods: A parallel-group randomized controlled experiment was conducted and analyzed in 2014 using an online survey with a convenience sample of 3,655 U.S. adolescents aged 13–17 years who had never tried e-cigarettes. Adolescents in the treatment group viewed four e-cigarette TV advertisements.
Results: Adolescents in the treatment group reported a greater likelihood of future e-cigarette use compared with the control group. ORs for the treatment group were 1.54 (p p Conclusions: Exposure to e-cigarette advertising had relatively large and consistent effects across experimental outcomes. Together with the simultaneous increase in e-cigarette advertising exposure and e-cigarette use among adolescents, findings suggest that e-cigarette advertising is persuading adolescents to try this novel product. This raises concerns that continued unregulated e-cigarette advertising will contribute to potential individual- and population-level harm.

Meanwhile, neither the FDA or the FTC has even proposed prohibiting e-cig ads on TV and radio.
Here is the RTI press release:
RESEARCH TRIANGLE PARK, NC— Adolescents who are exposed to e-cigarette TV advertising are more likely to try e-cigarettes in the future, according to a groundbreaking experiment from researchers at RTI International. Although advertising and adolescent use of e-cigarettes have simultaneously increased in recent years, this is the first study to demonstrate a direct link between adolescents' exposure to advertising and their likelihood of future use.
"Nicotine is highly addictive, and many questions remain about the safety of e-cigarettes. Adolescents in the United States are routinely exposed to e-cigarette advertisements that feature celebrities who tout e-cigarettes as a smarter alternative that you can use virtually anywhere, without the guilt and without affecting the people around you," said Matthew Farrelly, Ph.D., chief scientist at RTI. "Our findings suggest that e-cigarette TV advertisements are successfully convincing adolescent viewers to try the novel products they promote."
These findings, published in the American Journal of Preventative Medicine, come on the heels of the FDA's final public workshop, held in early June, to discuss the public health implications of e-cigarettes. Last April the FDA proposed a rule that would give the agency the authority to regulate e-cigarettes as a tobacco product and prohibit their sale to children under the age of 18. Yet while conventional cigarette ads have been banned from TV since 1971, this new rule will not restrict any advertising of e-cigarettes.
Use of e-cigarettes among high school students tripled in the past year and is now even higher than conventional cigarette use, according to a recent CDC study. At the same time, TV advertising of e-cigarettes has grown dramatically, despite questions and concerns about their safety.
A 2014 RTI study, published in Pediatrics, found that youth exposure to electronic cigarette advertisements on television increased by 256 percent from 2011 to 2013 and young adult exposure to e-cigarette ads jumped 321 percent in the same time period. 
"There is substantial evidence that conventional cigarette advertising increases youth smoking, but no direct evidence supports similar effects for e-cigarette advertising," Farrelly said. "This study fills that critical gap in our understanding of how e-cigarette advertising affects youth."
Using a sample of 3,655 U.S. adolescents who had never used e-cigarettes, the randomized control experiment found that adolescents exposed to four e-cigarette TV advertisements reported a 50 percent higher likelihood of future use than the control group. Similarly, the group exposed to the ads was more likely to express positive attitudes about e-cigarettes—that they are cool, safe, fun, healthy and enjoyable.
"It is little wonder that adolescents hold these beliefs, given that e-cigarettes have been advertised as the healthy and socially accepted alternative to conventional cigarettes since entering the market in 2004," Farrelly said. "Although the negative health effects of cigarettes are firmly established, many questions remain about the safety of e-cigarettes, which include nicotine but not tobacco."
Nicotine is a highly addictive substance that negatively affects adolescents' brain development, with increased anxiety and depression, and may make them more susceptible to conventional cigarettes, according to researchers.
Farrelly warns "the lack of restrictions on e-cigarette advertisements, which can be seen anywhere from Comedy Central to the Super Bowl, could have significant implications for the rates of e-cigarette use among adolescents and their health." 
A previous RTI study also found that particles found in e-cigarette vapors might cause or worsen acute respiratory diseases, including asthma and bronchitis, among youth. Up to 40 percent of particles emitted by an e-cigarette can deposit in the deepest area of a teen's lungs, according to research.

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