Socioeconomic status and adolescent e-cigarette use: The mediating role of e-cigarette advertisement exposure

Abstract

Among adolescents, low socioeconomic status (SES) is associated with greater exposure to tobacco cigarette advertising and cigarette use. However, associations among SES, e-cigarette advertising and e-cigarette use are not well understood. This study examined exposure to e-cigarette advertisements as a mediator of the relationship between SES and adolescent e-cigarette use. Adolescents (N = 3473; 51% Female) from 8 high schools in Connecticut completed an anonymous survey in Spring 2015. Mediation analysis was used to examine whether the total number of sources of recent e-cigarette advertising exposure (e.g., TV, radio, billboards, magazines, local stores [gas stations, convenience stores], vape shops, mall kiosks, tobacco shops, social media) mediated the association between SES (measured by the Family Affluence Scale) and past-month frequency of e-cigarette use. We clustered for school and controlled for other tobacco product use, age, sex, race/ethnicity and perceived social norms for e-cigarette use in the model. Our sample recently had seen advertisements via 2.1 (SD = 2.8) advertising channels. Mediation was supported (indirect effect: β = 0.01, SE = 0.00, 95% CI [0.001, 0.010], p = 0.02), such that higher SES was associated with greater recent advertising exposure, which, in turn, was associated with greater frequency of e-cigarette use. Our study suggests that regulations to reduce youth exposure to e-cigarette advertisement may be especially relevant to higher SES youth. Future research should examine these associations longitudinally and evaluate which types of advertisements target different SES groups.

Race, Educational Attainment, and E-Cigarette Use

“…[31] Smoking conventional and e-cigarettes are most common among individuals with the lowest levels of educational attainment and income. [27][28][29][30][31]45] The major contribution of this study, we believe, is not on the main effects of education and income on e-cigarette use but supportive evidence of the MDRs theory for e-cigarette use which is an emerging behavioral risk factor in the US and worldwide. Although a few recent studies have shown similar results on smoking cigarettes [8,18] and drinking alcohol, [6,40] no previous studies had shown this pattern for e-cigarette use.…”

“…Studying socioeconomic determinants of e-cigarette use are particularly important [25][26][27] because these products are relatively recent health risk products to enter the market and are quickly growing in popularity. [28][29][30][31] Although the evidence is still in its infancy, [32] e-cigarettes can be considered a hazard as well as harm-reduction strategy. [33,34] When compared to non-smokers, still some risks are associated with electronic cigarettes.…”

Prevalence and Sociodemographic Correlates of Adolescent Use and Polyuse of Combustible, Vaporized, and Edible Cannabis Products

“…Socioeconomic disparities in use were characteristically observed for combustible and edible cannabis, yet virtually absent for vaporized products, similar to recently reported evidence of associations of low SES with combustible but not vaporized tobacco product use in Connecticut youth. 26 Whether the comparatively high initial cost of vaporized cannabis products is a financial barrier that prohibits access in teenagers with lower SES, certain features of vaporized products disproportionately appeal to higher-SES youths, or other factors explain this trend warrant future study. Considerably higher prevalence of polyuse of cannabis products was observed for lower (vs higher) SES, boys (vs girls), and certain racial/ethnic groups.…”

Parental Educational Attainment and Relatives’ Substance Use of American Youth: Hispanics’ Diminished Returns

“…Another potential mechanism that has not yet been tested is the role of social networks. SES may have weaker than expected effects on reducing tobacco use in the social networks of ethnic minorities than Whites [30]. As a result of such MDRs, highly educated Hispanics and Blacks might be exposed to social networks that have higher tobacco involvement.…”