A scoping review on disparities in exposure to advertising for e-cigarettes and heated tobacco products and implications for advancing a health equity research agenda

Abstract

Background Disparities in exposure to and density of tobacco advertising are well established; however, it is still unclear how e-cigarette and heated tobacco product (HTP) advertising vary by age, education, sex, gender identity, race/ethnicity, sexual orientation, socioeconomic status (SES), and/or urban/rural area. Through a scoping review, we sought to identify potential disparities in exposure to e-cigarette and HTP advertising and promotion across populations. Methods In January 2020, a systematic literature search was conducted in five databases: PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. The search was updated in October 2020. Articles reporting on exposure to e-cigarette and/or HTP advertising and promotion across age, education, sex, gender identity, race/ethnicity, sexual orientation, SES, and/or urban/rural areas were included for full-text review (n = 25). Of those, 15 were deemed relevant for data extraction. Results The majority of the studies were from the U.S. (n = 12) and cross-sectional (n = 14). Studies were published between 2014 and 2020 and focused on determining causal relationships that underlie disparities; only one study assessed HTP advertising and promotion. Exposure to e-cigarette and HTP advertising was assessed at the individual-level (e.g., recall seeing ads on television) and at the neighborhood-level (e.g., ad density at the point-of-sale). Studies addressed differences across age (n = 6), education (n = 2), sex (n = 6), gender identity and sexual orientation (n = 3), race/ethnicity (n = 11), SES (n = 5), and urban/rural (n = 2). The following populations were more likely to be exposed to e-cigarette advertising: youth, those with more than a high school diploma, males, sexual and gender minorities, Whites, and urban residents. At the neighborhood-level, e-cigarette advertisements were more prevalent in non-White neighborhoods. Conclusions Exposure to e-cigarette/HTP advertising varies based on sociodemographic characteristics, although the literature is limited especially regarding HTPs. Higher exposure among youth might increase tobacco-related disparities since it can lead to nicotine/tobacco use. Research should incorporate and apply a health equity lens from its inception to obtain data to inform the elimination of those disparities.

E-cigarette Marketing Expenditures in the United States From 2016 to 2021: Targeted Media Outlets Geared Toward People Who Are at Increased Risk for Tobacco Use

“…Higher radio advertising expenditures also were associated with market areas that had smaller male populations, which is in line with some other work, 35 but in contrast to results from a recent systematic review indicating that males are more likely to be exposed to e-cigarette advertisements than females. 18 …”

“…Several studies have investigated e-cigarette advertising exposure from the perspective of consumers, 18 yet little is known about how e-cigarette companies allocate advertising expenditures. Industry advertising practices need to be monitored as FDA marketing authorization decisions and marketing stipulations are made.…”

IQOS and cigarette advertising across regulatory periods and population groups in Israel: a longitudinal analysis

“…Partial tobacco product advertisement bans might not reduce the industry’s spending on advertising, mainly because tobacco companies shift their advertisement to other venues such as digital platforms and points of sale (POS) 25–28. A recent study with IQOS POS retailers in Israel suggests that PMI increased direct marketing to the POS after an advertisement ban went into effect 3 29.…”

“…In addition, tobacco company advertisements might target certain subpopulations 28 30–33. For example, menthol cigarette advertising has disproportionately targeted the African-American community in the USA with more frequent ads and using relatable cultural icons 28–30.…”

“…In addition, tobacco company advertisements might target certain subpopulations 28 30–33. For example, menthol cigarette advertising has disproportionately targeted the African-American community in the USA with more frequent ads and using relatable cultural icons 28–30. American Indians and Alaska natives have been targeted by Natural American Tobacco, which uses their traditional symbols and colours 33.…”