Youth vaping skyrockets as 85% are exposed to e-cig ads, despite global bans

By Hugo Francisco de SouzaOct 30 2023Reviewed by Susha Cheriyedath, M.Sc.

In a recent study published in the journal Tobacco Induced Diseases, researchers conducted a four-nation-wide cross-sectional online survey to assess youths’ exposure to media-based e-cigarette advertising. Despite World Health Organization (WHO) recommendations and national legislature restricting e-cigarette advertising, study findings revealed that 85% of youth sampled had been exposed to one or more modes of e-cigarette advertising. The study further investigated the association between media exposure and e-cigarette use and found a significant association between these variables.

Study: Exposure to e-cigarette advertising and young people’s use of e-cigarettes: A four-country study. Image Credit: Created with the assistance of DALL·E 3

What Are E-Cigarettes and Why Are They Controversial?

Electronic cigarettes, also called “e-cigs,” “vapes,” “e-hookahs,” “vape pens,” and “electronic nicotine delivery systems (ENDS), are battery-powered devices that simulate tobacco smoking. Despite e-cigs being popularized as a healthier alternative to conventional cigarette smoking, research has identified significant neural and cardiovascular damage and an increased risk of nicotine addiction, especially in children, adolescents, and young adults, as a consequence of their use.

Global Efforts and Regulations: Are They Enough?

Deriving from this research, the World Health Organization (WHO) has recommended banning all e-cig advertising, sponsorship, and promotion forms. The WHO Framework Convention on Tobacco Control, adopted as a part of the 56th World Health Assembly held in Geneva, Switzerland, on 21 May 2003, requires all signatories to enforce this ban. However, while most national legislatures have been updated to include these regulatory policies, a growing body of evidence alludes to continued advertisements, especially over the Internet and other hard-to-monitor digital media sources.

This is alarming, especially given that anecdotal evidence suggests inverse relationships between youths’ harm perceptions (a function of media exposure) and e-cig use. However, few studies have aimed to investigate the specific forms of media exposure formally and the potential additive effects of multiple or prolonged advertisements on e-cig outcomes, with research being restricted to the United States (US).

The Study Design: Investigating Media Exposure Across Four Nations

In the present study, researchers aimed to investigate e-cig media exposure in young adults (age 18-30), the different forms of media exposure, and any potential association between e-cig use and the amount of exposure. The online cross-sectional study was conducted across four countries with diverse ethnicities and a spectrum of e-cig legislature.

“India has amongst the strictest regulatory environments in the world: nicotine and non-nicotine e-cigarettes are banned and advertising is not permitted. The UK has the most liberal laws across the four included countries.”

Australia and China, the remaining two countries, represent a middle ground between India and the United Kingdom’s (UK’s) legislature – Australia allows for the sale of non-nicotine e-cigs and nicotine e-cigs with a prescription. China allows adults (≥18 years) to purchase nicotine e-cigs. Both countries have banned advertisements of e-cigs through the media.

The sample group comprised ~1,000 survey respondents per nation across the four countries, with care taken to ensure that male and female representation was uniform across cohorts. The survey comprised a blind (participants were unaware of the contents of the study prior to receiving it) 15-minute-long questionnaire delivered between November and December 2021. Approximately 82% of respondents completed the survey, but 8% were removed from the analyses following quality assessment.

In addition to questions regarding e-cig knowledge, use, and media exposure, the questionnaire collected data on participants’ demographics, including sex, age, educational level, and income. Deriving from the US National Youth Tobacco Survey, researchers identified and listed 24 forms of media. To assess the association between multiple modes of media exposure and e-cig use, study participants were asked to reveal the number of forms applicable to them.

Statistical analyses comprised chi-squared tests and mixed effects logistic regression models. The models were corrected to account for country-specific clustering.

Key Findings: The Impact of Media Exposure on Vaping Rates

Out of the 4,107 participants included in the study, 1,011 reported a lack of knowledge about e-cigarettes. These participants were predominantly from China (50%) and India (35%). Approximately 85% of respondents with knowledge of e-cigs reported at least one form of media exposure, with this number higher in the user cohort (95%) than respondents who did not use e-cigs (79%).

Assessment of modes of media exposure revealed an average of five forms per respondent, with a majority of exposure being found on social media platforms like Douyin (China – 50%) and Instagram (Australia/India/UK – 39%) compared to general internet browsing (29%).

Logistic regression models revealed that the odds of e-cig consumption increased by 5% for every additional mode of media exposure. Other significant factors associated with e-cig consumption included being a current or previous tobacco smoker or having friends or family members who use e-cigs. Male participants were also found to be more likely to vape than their female counterparts.

Conclusions: Urgent Need for Tighter Regulations

The present study investigates the number of modes of media exposure pertaining to e-cigs and how this exposure translates to e-cig adoption amongst young adults aged 18-30 years. The study comprised over 4,000 respondents across India, China, Australia, and the UK, revealing that 85% of respondents had been exposed to at least one form of e-cig-promoting media. Modes of exposure were mainly online and primarily concentrated on social media platforms like Douyin and Instagram.

Alarmingly, every unit of media exposure was associated with a 5% increased probability of taking up vaping. This study highlights the importance of enforcing advertisement bans across nations and, wherever applicable, cross-border policies to curb the online spread of e-cig-promoting media.