Dramatic Jump in e-Cigarette Advertising Aimed at Youth

Deborah Brauser

June 02, 2014

e-Cigarette companies have substantially increased their advertising to a broad television-viewing audience, resulting in an incredibly dramatic jump in exposure of its products to both teens and young adults, new research shows.

A study of Nielsen records showed that exposure to e-cigarette television ads increased by 256% from 2011 to 2013 for youth between the ages of 12 and 17 years, and increased by 321% for those between the ages of 18 and 24 years.

In addition, these ads appeared on programs ranked among the 100 highest rated for youth during the 2012-2013 season. Interestingly, more than 80% of these ads in 2013 were driven by a campaign for Blu eCigs alone.

"Unlike in the early days of e-cigarette advertising, it seems that television ads have been consolidated by very few e-cigarette brands," lead author Jennifer Duke, PhD, researcher and senior public health analyst at RTI International in Research Triangle Park, North Carolina, told Medscape Medical News.

"This is really the first study that extensively analyzes these trends in exposure to e-cigarette advertising," added Dr. Duke.

The investigators note that although research on the health risks of e-cigarettes has been mixed, "television advertising may be promoting beliefs and behaviors that pose harm to the public health."

The study is published in the June issue of Pediatrics.

Advertising Unregulated

e-Cigarettes have not been approved by the US Food and Drug Administration (FDA), and so there are no regulations governing advertising of these products.

Dr. Jennifer Duke

"E-cigarette companies currently advertise their products to a broad audience that includes 24 million youth," write the investigators. "The content of these [television] ads may appeal to young people because they emphasize themes of independence and maturity."

The extent to which youth are exposed to such ads has not been examined before, and so the researchers sought to assess trends in the United States.

They analyzed calendar quarter, year, and sponsor data from Nielsen television records on household audience exposure to e-cigarette ads broadcast across US markets. Target rating points (TRPs) were calculated as a measurement of television exposure, evaluating reach and frequency.

Results showed that all youth were exposed to fewer than 100 quarterly TRPs of e-cigarette ads throughout 2011 and the first half of 2012. This number jumped to a high of 347 TRPs between April and June 2013, before dropping to 275 TRPs between July and September 2013.

This population was also exposed to 1054 cumulative yearly TRPs between October 2012 and September 2013.

Although e-cigarette television ad exposure increased by 256% for this age group between 2011 and 2013, it increased even more for young adults, at 321%.

Quarterly TRPs peaked at 611 from April to June 2013 for this slightly older age group, and they were exposed to 1742 cumulative yearly TRPs.

Targeting Youth

In addition, 75.5% of ad exposure to youth between January 2011 and September 2013 and 75% of exposure to young adults occurred on cable networks, including TV Land, Comedy Central, and VH1.

Interestingly, the American Movie Channel aired the most e-cigarette ads, reaching 8% of youth audiences.

As for broadcast networks, e-cigarette ads appeared on family-type programs such as Survivor, as well as shows such as The Bachelor and Big Brother, which have been shown to be highly popular with youth.

A total of 81.7% of all nationally aired TRPs aimed at youth and 80.4% of TRPs aimed at young adults in 2013 were from Blu eCigs. The next highest percentage was from FIN, but at only 7.1% and 6.7%, respectively.

"The most widely aired e-cigarette advertisement features a film actor [Stephen Dorff] exhaling vapor while informing viewers of numerous benefits of 'smoking' the product, closing with the ad tagline, 'We're all adults here. It's time to take back your freedom,' " write the investigators.

Overall, "the reach and frequency of these ads increased dramatically between 2011 and 2013. If current trends continue, youth awareness and use of e-cigarettes are likely to increase," add the researchers.

Dr. Duke noted that future research may examine e-cigarette advertising to youth in online shows and noted that recent research has examined e-cigarette ads on Web sites.

"Knowing more about the online environment would be potentially helpful," she said.

She added that although e-cigarette companies report that they do not advertise to youth and that that is not their intended audience, "I think it's difficult in a medium such as television for that to be true."

"It's clear that with increased advertising levels over time, these ads are reaching youth with their positive messages about e-cigarettes," said Dr. Duke.

As reported by Medscape Medical News, a recent study showed that young adult smokers who see others using e-cigarettes have a significantly increased urge to smoke both e-cigarettes and traditional tobacco cigarettes.

"And now youth are being exposed to depictions of adults using these products in a very visual and graphic way on television," added Dr. Duke.

FDA Regulations Needed

In an accompanying editorial, Emily K. Duffy, MD, and Brian P. Jenssen, MD, from the Children's Hospital of Philadelphia, Pennsylvania, write that images of "a rugged actor with a prematurely lined face" and "a flaxen-haired actress" discussing the sex appeal of puffing in a bar are surprisingly not from television archives when tobacco advertising was unregulated.

Instead, these are "from a new, and relatively unregulated, chapter in the saga of nicotine-containing products," they write.

Dr. Duffy and Dr. Jenssen note that as the popularity of e-cigarettes increases, "so too does the need for product and marketing regulations at the federal level and sales restrictions to minors at the state and local levels."

They also point out that although flavored cigarettes other than menthol have been banned since 2009, e-cigarettes' youth-skewing flavors can include peach or even bubble gum.

"Once rare, these products have become much more visible over the past few years, particularly with the aid of television commercials for 'blu eCigs' (owned by the Lorillard Tobacco Company), filling a void in televised cigarette commercials since their ban in 1970."

For clinicians, they recommend telling teen patients who have tried e-cigarettes but not traditional cigarettes about the potential for nicotine addiction and that there are unknown risks from these unregulated products.

On the other hand, the editorialists note that for adults interested in quitting smoking, e-cigarettes may serve as an effective cessation tool.

"Although it is difficult to endorse a product not yet regulated for quality or consistency, studies…indicate what has already been intrinsically suspected: e-cigarettes could be a potential weapon in the battle against tobacco addiction," they write.

Still, they reiterate that regulation by the FDA is needed.

"Pediatricians can advocate with their local and national lawmakers to encourage this needed oversight, a necessary step toward ensuring that these devices do the most possible good and the least possible harm."

The study authors, Dr. Duffy, and Dr. Jenssen report no relevant financial relationships.

Pediatrics. Published online June 2, 2014. Abstract, Editorial

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