IMPORTANCE Cigarette marketing contributes to initiation of cigarette smoking among young people, which has led to restrictions on use of cigarette advertising. However, little is known about other tobacco advertising and progression to tobacco use in youth and young adults. OBJECTIVE To investigate whether receptivity to tobacco advertising among youth and young adults is associated with progression (being a susceptible never user or ever user) to use of the product advertised, as well as conventional cigarette smoking. DESIGN, SETTING, AND PARTICIPANTS The Population Assessment of Tobacco and Health (PATH) Study at wave 1 (2013-2014) and 1-year follow-up at wave 2 (2014-2015) was conducted in a US population-based sample of never tobacco users aged 12 to 24 years from wave 1 of the PATH Study (N = 10 989). Household interviews using audio computer-assisted self-interviews were conducted. EXPOSURES Advertising for conventional cigarettes, electronic cigarettes (e-cigarettes), cigars, and smokeless tobacco products at wave 1. MAIN OUTCOMES AND MEASURES Progression to susceptibility or ever tobacco use at 1-year follow-up in wave 2. RESULTS Of the 10 989 participants (5410 male [weighted percentage, 48.3%]; 5579 female [weighted percentage, 51.7%]), receptivity to any tobacco advertising at wave 1 was high for those aged 12 to 14 years (44.0%; 95% confidence limit [CL], 42.6%-45.4%) but highest for those aged 18 to 21 years (68.7%; 95% CL, 64.9%-72.2%). e-Cigarette advertising had the highest receptivity among all age groups. For those aged 12 to 17 years, susceptibility to use a product at wave 1 was significantly associated with product use at wave 2 for conventional cigarettes, e-cigarettes, cigars, and smokeless tobacco products. Among committed never users aged 12 to 17 years at wave 1, any receptivity was associated with progression toward use of the product at wave 2
Purpose Youth who engage with online tobacco marketing may be more susceptible to tobacco use than unengaged youth. This study examines online engagement with tobacco marketing and its association with tobacco use patterns. Methods Cross-sectional analysis of youth aged 12–17 years who participated in Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study (N=13,651). Engagement with tobacco marketing was based on ten survey items including signing up for email alerts about tobacco products in the past six months. Logistic regression was used to examine association of online engagement with tobacco marketing and susceptibility to use of any tobacco product among never-tobacco users, ever having tried tobacco, and past 30-day tobacco use. Results An estimated 2.94 million US youth (12%) engaged with ≥ 1 forms of online tobacco marketing. Compared to no engagement, the odds of susceptibility to the use of any tobacco product among never-tobacco users was independently associated with the level of online engagement: adjusted odds ratio (AOR) =1.48 (95% confidence interval [CI] 1.24–1.76) for 1 form of engagement and AOR=2.37 (95% CI 1.53–3.68) for ≥2 forms of engagement. The odds of ever having tried tobacco were also independently associated with level of online engagement: AOR=1.33 (95% CI 1.11–1.60) for 1 form of engagement and AOR=1.54 (95% CI 1.16–2.03) for ≥2 forms of engagement. The level of online engagement was not independently associated with past 30-day tobacco use. Conclusion Online engagement with tobacco marketing may represent an important risk factor for onset of tobacco use in youth.
Curiosity is a potential risk factor for electronic cigarette (e-cigarette) use, which has increased considerably among US youth in recent years. We examined the relationship between curiosity about e-cigarettes and perceived harm, comparative addictiveness, and e-cigarette advertisement exposure. Data came from the 2014 National Youth Tobacco Survey, a nationally representative survey of U.S. middle and high school students. In 2014, 2.5% of middle school and 9.2% of high school students currently used cigarettes, while 3.9% of middle school and 13.4% of high school students reported current e-cigarette use. Among never e-cigarette users (n= 17,286), descriptive statistics assessed curiosity about e-cigarettes by combustible tobacco use, sex, race/ethnicity, and school level. Associations between curiosity and perceived harm (absolute and comparative to cigarettes), comparative addictiveness, and e-cigarette advertising exposure were explored using multivariate models in 2015. Among youth who never used e-cigarettes, 25.8% reported curiosity about e-cigarettes. Higher levels of perceived absolute harm and comparative harm were associated with lower levels of curiosity, while no association was observed between comparative addictiveness and curiosity. Among never combustible tobacco users, the odds of high curiosity were greater among non-Hispanic blacks (odds ratio (OR): 1.39; 95% confidence interval (CI):1.02–1.88), Hispanics (OR=1.79; 95%CI:1.48–2.16), and non-Hispanic ‘Other’ (OR=1.47; 95%CI:1.15–1.89) race/ethnicities than non-Hispanic whites. One-quarter of middle and high school students who have never used e-cigarettes are curious about the products, with greater curiosity among those with lower perceptions of harm from these products. These findings may help inform future strategies aimed at reducing curiosity about e-cigarettes among youth.
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