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Cigarette sales get a boost from TV commercials for e-cigs, says study

Apr 21st, 2016
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Discovery of “spillover effect” may provide new ammunition for calls for regulatory oversight

http://www.campaignlive.com/article/cigarette-sales-boost-tv-commercials-e-cigs-says-study/1392249

It’s been nearly 50 years since Congress banned cigarette commercials from the airwaves. But a new study suggests the rapid proliferation of e-cigarette commercials may be lifting the sales of cigarettes, too, offering an unexpected path back to TV for the tobacco industry.

According to the study, Advertising, Habit Formation and U.S. Tobacco Product Demand, funded by the U.S. Food and Drug Administration, TV advertisements for e-cigarettes create a “spillover effect” that also increases demand for cigarettes. “If you increase e-cigarette advertisement, then cigarette demand is going to increase slightly,” said Yuqing Zheng, an agricultural economist the University of Kentucky and lead author of the study.

Researchers compared advertising data from Kantar Media with point-of-sale data at outlets that sold five different kinds of tobacco or nicotine products between 2009 and 2013. What they found was that for every increase in e-cigarette advertising on television, there was an accompanying lift — however small — of cigarette sales.

That rise in cigarette sales is small but statistically significant: one-one hundredth of 1% whenever e-cigarette advertising doubles. But e-cigarette advertising increased 17-fold between 2011 and 2014, so it could be contributing to tens of millions of dollars in cigarette sales.

Though the FDA has petitioned for regulatory control of the e-cigarette market, there are currently no restrictions on e-cigarette advertising, the bulk of which take the form of TV commercials. The findings of the study, which was published in the American Journal of Agricultural Economics, could renew calls for e-such oversight, said the authors. “Such results may lend support to those who advocate that more regulations on e-cigarette marketing are needed,” they wrote.

The study found that the spillover effect was restricted to TV. E-cigarette magazine ads did not have the same positive effect on cigarette sales. “We consistently find that TV advertising is the most effective way to enhance demand,” said Zheng.

Why e-cigarette ads increase cigarette demand is unclear, though Zheng speculated there could be an “umbrella” effect at work. “A lot of the cigarette and e-cigarette brands belong to the same parent company, so when you do advertise for e-cigarettes, it’s probably going to enhance the image of the parent company which owns the cigarette brand, so that might stimulate some cigarette smoking as well,” he said. Intentionally or not, cigarette manufacturers may have found a way to boost sales by advertising a different product in their inventories.

These could be problematic numbers for e-cigarette manufacturers, who have been resisting calls for the regulation of either their products or their advertising. If further research supports the study’s finding that e-cigarette advertising increases cigarette sales, then continuing to allow unregulated e-cigarette advertising “might undermine the efforts to reduce cigarette smoking,” the study said. “If a new policy were to prohibit e-cigarette television ads, similar to what is imposed for cigarettes, the model predicts a small drop in consumer demand for e-cigarettes, and a minor decrease in cigarette demand.”

Whether the prospect of that minor decrease helps anti-smoking advocates win regulatory controls for e-cigarettes and their ads remains to be seen.

Parliamentary committee delivers 20 recommendations on e-cigarettes

Feb 24th, 2016
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http://www.adelaidenow.com.au/news/south-australia/parliamentary-committee-delivers-20-recommendations-on-ecigarettes/news-story/3801de5dc4984fcad271524f7a81116b?nk=0611f97db29bbf0213b82364550de3fc-1456352062

E-CIGARETTES should be banned in non-smoking areas and retailers should not be allowed to sell the vaporisers to children, a parliamentary committee recommends.

Vaporisers also should feature health warnings and should not be decorated with “child-like aspects such as diamantés and cartoon characters” which may encourage young people to take up the habit of “vaping”.

For the same reason, the committee also urges against selling “sweet and confectionery flavoured e-liquids” to be used in the vaporisers.

It is believed about 20,100 South Australians use e-cigarettes — or about 1.2 per cent of the population — and the devices are growing in popularity.

The battery-operated devices vaporise a refillable cartridge of nicotine solution to create a vapour that the user inhales, simulating the action of smoking.

Some use flavoured liquids without nicotine.

E-cigarettes have been sold in Australia for about four years but legislation governing their sale and use varies around the nation.

Concerned at the confusion around the relatively new products, and the potential long-term health risks, Labor MP Annabel Digance moved in May to establish a Select Committee into E-Cigarettes.

The final report of the committee, tabled in Parliament today, makes 20 recommendations including:

BANNING e-cigarettes in areas where tobacco smoking is banned.
PREVENTING the sale of e-cigarettes to people aged under 18.
REQUIRING health warnings on e-cigarette devices and full lists of ingredients on e-liquid packaging.
REQUIRING childproof packaging on e-liquid containers.
BANNING advertising of e-cigarettes or offering pricing specials or promotions.
CALLING for more research on the effects of e-cigarettes on users, including pregnant women and foetuses, infants and children and people with respiratory illness or chronic illness.

Health Minister Jack Snelling has pledged to consider the recommendations in any future regulation of e-cigarettes.

There is strong debate over whether vaporisers encourage the habit of smoking or help people to quit by simulating the action without delivering the chemicals.

“We just don’t know whether e-cigarettes are effective in helping people to quit smoking without causing potentially new damaging health effects,” Ms Digance said.

She added that it was “unclear whether e-cigarettes could act as a gateway into smoking and nicotine dependence for our young people”.

“The younger a person starts smoking the more difficult it can be to quit later on,” Ms Digance said.

“While studies are under way to explore the health effects of e-cigarettes, it will be some time, possibly decades, before we really understand how they affect a person’s health.

“The World Health Organisation is calling on governments to regulate e-cigarettes until the safety of the devices and their peripheral components, such as the vaporised solution contained within them, are established.”

Opposition committee member Vincent Tarzia raised concerns that some of the recommendations would diminish the potential harm minimisation benefits of e-cigarettes.

“The research is clear that e-cigarettes are far less dangerous than smoking tobacco and there is a public health benefit if people choose to use e-cigarettes instead of smoking tobacco,” Mr Tarzia said.

“As a consequence there is a public health benefit if tobacco smokers are switching to e-cigarettes and any new regulations should not hinder that movement.

“The report’s recommendation that e-cigarettes shouldn’t be sold alongside tobacco products has the potential to undercut this public health benefit.”

Mr Tarzia supported calls for more research on the long-term health impacts of using the vaporisers.

The committee received 142 submissions and took evidence from 11 people, including from tobacco companies, e-cigarette retailers and users, and tobacco smokers.

Tobacco companies targeting our generation through e-cigarette advertising

Jan 29th, 2016
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http://www.dailycal.org/2016/01/29/341494/

Before I began college, I couldn’t have identified an e-cigarette if I saw one. During my first semester at San Jose State University, however, I sat next to a student in my community health class who was, to my surprise, openly vaping.

While smoking a traditional cigarette in a classroom, much less a health class, is unthinkable, e-cigarettes have emerged as a strangely acceptable practice, especially among youth.

Although I’ve always known cigarettes can kill, the “truth” campaign helped me learn just how much the tobacco companies were willing to do to keep people addicted to nicotine. These days it seems that health organizations are fighting the same battles as they did years ago, but this time against e-cigarettes.

I’m taking notice because now it’s personal. Tobacco companies are targeting my generation — the teenagers and young adults who will write the next chapter of California’s history.

Have you seen e-cigarette ads? Do they seem to be speaking specifically to you? That’s because e-cigarettes are heavily advertised on television and radio and targeted at youth and young adults. Now think about the last time you saw a traditional cigarette ad. Having trouble? That’s because traditional cigarette ads were banned from TV and radio more than 40 years ago.

You can even find e-cigarette samples at concerts, bars and festivals now, while sampling of traditional cigarettes is banned. I’ve also learned that of the nearly $119 million spent on e-cigarette advertising in 2014, 89 percent came from tobacco companies. In fact, some of the most well-known e-cigarette brands are owned by tobacco companies. For example, tobacco giant RJ Reynolds owns Vuse, the nation’s top-selling electronic cigarette brand.

Recent research shows teens and young adults, who otherwise would never have started smoking traditional cigarettes, are significantly more likely to start if they have vaped. The tobacco companies are paying attention. In three years, the amount of money spent on advertising e-cigarettes increased more than 1,200 percent. It seems clear to me that the tobacco industry is investing in this new market to recruit the next generation of smokers.

And there’s a lot they’re not telling us about what’s actually in these products. E-cigarette companies are not currently required to disclose the ingredients — and toxins — in their products, and there are no safety or health standards associated with e-cigarettes.

Take a look at the some facts:

· Most e-cigarettes contain nicotine, a neurotoxin as addictive as heroin and cocaine.
· E-cigarette use among young adults, ages 18-24, increased from 2.4 percent in 2012 to 8.3 percent in 2013. Young adults are three times more likely to use e-cigarettes than those 30 and older.
· E-cigarettes appeal to a younger audience with fruit, candy and alcohol-flavored e-juice.
· It’s not harmless water vapor. E-cigarettes emit an aerosol, which contains harmful chemicals that not only pose health risks to those who use them, but to the people around them as well.

What really scares me though is that all of the e-cigarette marketing, and rapidly increasing usage, is making the act of smoking seem normal again, and it keeps our generation addicted to nicotine. This directly undermines all of the progress California has made to reduce smoking rates, save lives and cut healthcare costs.

This year, the California Department of Public Health released its first campaign to educate Californians about the health risks of e-cigarettes and the aggressive marketing practices used to recruit the next generation of smokers. As students, we are taught to question everything, so I encourage you to question vaping and educate yourself on the health impacts. Just because e-cigarettes may be less harmful than cigarettes in the short term does not mean they are safe. Together we can protect the health of all Californians and especially make sure that youth do not fall victim to the tobacco industry’s marketing.

Isra Ahmad is the Youth Liaison for the Board of Directors at Truth Initiative (formerly known as American Legacy Foundation) and is a current UC Berkeley student where she will receive her Master in Public Health (M.P.H.) in May 2016.

Go to stillblowingsmoke.org to learn more.

Snuff out e-cig marketing to kids

Jan 17th, 2016
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http://www.nydailynews.com/opinion/stringer-james-snuff-e-cig-marketing-kids-article-1.2498445

Walk down any street in our city and you’re sure to see them: seductive neon signs advertising the latest flavors of electronic cigarettes, the newest trend in nicotine delivery.

“VAPE,” they plead. For those of us who remember the days of Joe Camel, it’s a startling throwback to a time when cigarette advertising targeted consumers of all ages, including kids.

The dirty secret is that e-cigarette companies are exploiting a loophole in laws that ban marketing tobacco products to kids. Which is why we are urging e-cig companies to take down this dangerous marketing — and calling on the federal government to investigate and regulate the e-cigarette industry immediately.

Throughout the 20th century, government stood by as the tobacco industry hooked millions of American youth on cigarettes. That dangerous neglect ultimately cost the nation trillions of dollars in health care costs while causing endless other tobacco-related harms.

Only in 1998, years after a few enterprising elected officials finally took the fight to the cigarette makers, did the tobacco companies and 46 state attorneys general sign a settlement agreement, which imposed hundreds of billions of
dollars in fines on the industry and promised to put an end to marketing to kids.

In fact, since the tobacco settlement, young people have been exposed to a flood of powerful and savvy anti-smoking marketing to counteract the peer pressure that still drives too many of them to smoke.

The era of Joe Camel was at last over, or so we thought. However, because the MSA does not apply to e-cigarettes, the tobacco companies are now pouring millions of dollars into e-cigarette advertising, including sponsoring events, using celebrity endorsements, promoting sweet flavors like “Cherry Crush” and “Mocha Mist” — and even using cartoons to hook our kids once again.

Sadly, these efforts are working. According to the Centers for Disease Control, more than 70% of American youth are exposed to e-cigarette advertising, and that is contributing to a surge in their popularity. E-cigarette consumption by high school students has soared in recent years, from 1.5% in 2011 to 13.4% in 2014, and among middle school students, it has more than tripled, from 1.1% in 2011 to 3.9% in 2014.

The industry line is that e-cigs are a safe alternative to smoking. While the full health effects of these addictive products is unknown, recent studies suggest a litany of public health risks.

Just last month, research from the Harvard School of Public Health found that a flavoring chemical linked to cases of severe respiratory disease exists in more than 75% of flavored electronic cigarettes. Moreover, the research about the damaging effects of nicotine on adolescent brain development is so clear that the Centers for Disease Control has declared, “no youth should use ecigarettes.”

We need urgent action to help unhook kids who are hooked — and prevent many more kids from getting hooked in the first place. We’re calling on the Federal Trade Commission to focus its efforts on how tobacco companies are marketing e-cigarettes to the next generation. But we still need to do more.

The Food and Drug Administration recently issued final proposed rules that would classify e-cigarettes as a “tobacco product” and allow the agency to mandate warning labels on e-cigarette packaging, bar purchase by anyone under 18 years old and limit marketing to youth.

Federal investigation and regulation of e-cigarettes is long overdue, but we can’t wait for Washington to act. That’s why we’re calling on companies to voluntarily apply the restrictions on cigarette marketing outlined in the tobacco settlement agreement to e-cigarettes — now.

We cannot allow history to repeat itself. We must protect our children from the clear and present danger posed by these new nicotine delivery devices.

Stringer is the controller of the City of New York. James is the city’s public advocate.

Research shows electronic cigarettes lower odds to stop smoking by 28%

Jan 16th, 2016
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http://www.examiner.com/article/research-shows-electronic-cigarettes-lower-odds-to-stop-smoking-by-28

The manufacturers of electronic cigarettes (e-cigs) have been pitching the idea that smoking e-cigs is better than smoking tobacco cigarettes or cigars. They have also promoted the idea that e-cigs are a way to stop smoking cigarettes or cigars. EMPR, a publication to keep medical practitioners informed of new developments, released an article by Steve Duffy, digital content editor, for EMPR on Jan. 14, 2016 titled “How Effective Are E-Cigarettes in Helping to Quit Smoking?”

Stephen A. Glantz, PhD, professor of medicine at University of California San Francisco (UCSF) was a co-author of the study. The major conclusion is that e-cigs impair quitting smoking cigarettes.

The irony is that quitting smoking is one of the main reasons both adults and kids use e-cigarettes, but the overall effect is less, not more, quitting.

E-cig usage in the US for youths tripled from 2013 to 2014 according to The Lancet Respiratory Medicine article “Electronic cigarettes: more light, less heat needed” that was published on Jan. 14, 2016 by Stephen L Bernstein. The abstract for the full article, which can be purchased for $31.50, outlines some of the problem with e-cigs.

Electronic nicotine delivery systems may not burn, but the controversy surrounding them certainly does. Barely a decade into their manufacture, distribution, and sale, these systems have become the most widespread new nicotine-containing product. Touted by clever marketing as a healthy alternative to cigarette smoking, e-cigarettes have rapidly captured a growing share of the tobacco-using market. In the USA, for example, use of e-cigarettes among adolescents tripled from 2013 to 2014.

The EMPR article outlined how the UCSF study was conducted and the conclusions that were reached from the combination of a very large set of studies.

The UCSF researchers reviewed 38 studies to examine the correlation between e-cigarette use and smoking cessation. They combined the results from this review with a meta-analysis of 20 studies which included control groups of smokers not using e-cigarettes. Data from this analysis revealed that those who used e-cigarettes were 28% less likely to quit than those who did not.

The fact that they are freely available consumer products could be important. The inclusion of e-cigarettes in smoke-free laws and voluntary smoke-free policies could help decrease use of e-cigarettes as a cigarette substitute, and, perhaps, increase their effectiveness for smoking cessation.

The basic facts of e-cigs usage are:

  • E-cigs are an effective device to increase the blood-nicotine levels of users
  • Nicotine is one of the most addictive substances legally sold to users
  • E-cig users become more addicted to nicotine as they continue use. One of the characteristics of any addictive substance is that it takes increased dosages of the substance (nicotine, heroin, cocaine, crack, etc.) to obtain the same level of “satisfaction”.
  • E-cigs are being specifically formulated with flavor agents to appear to younger users from middle school age to those in their early 20s.
  • E-cigs are focused on sale to minors. In Columbus, OH there are two e-cig stores within less than 0.5 miles of Centennial High School. There are thousands of flavors available. A random search on the web provides, Brandy, Bubble Gum, Cappuccino, Champagne, Coffee, Cool Mint Menthol Tobacco, and Cotton Candy, etc. The list goes for 13 pages for this vendor, Viking Vapor.com.
  • E-cigs are legally advertised on television, and in print media.
  • E-Cigs are not regulated as tobacco products by the FDA, and they can currently be used in most public places. Some states have banned sales of e-cigs to those under 18, and Hawaii has banned the sale and use of all tobacco products to those below 21.

A new generation of tobacco addicts is being created using e-cigs as the vehicle. E-cigs are dangerous to the health of users. Targeting minors by promoting and selling e-cigs exposes them to nicotine at an earlier age. The nicotine in e-cigs is a cardiovascular constrictor that increases blood pressure, heart rate, and produces cancer in the lungs, kidneys, liver and bladder. The propellant used in e-cigs degrades under high temperatures to irritate lung tissue and can be carcinogenic under some conditions.

The FDA is currently seeking formal jurisdiction over all forms of tobacco products, including e-cigarettes. The proposed regulations that would have FDA control of all tobacco products, with the prohibitions on e-cigs to match those for cigarettes with regard to public facility use, advertising, sales to minors and flavorings applied to e-cigs were sent to the White House on Oct. 23, 2015. There is major pressure by e-cig manufacturers, e-cig users, and members of Congress to have the White House water down the regulations or delay implementation for e-cigarettes.

There is no indication as of Jan. 16, 2016 that the White House has responded to approve the FDA regulation of e-cigs and all other tobacco products. There is a bill in Congress, HR-2058, that is attempting to override the FDA’s proposed regulation of these products. Call the White House to request that the FDA regulation of all tobacco products are supported and that HR-2058 is rejected. The numbers are 202-456-1111 or 202-456-1414.

Exposure to Electronic Cigarette Advertising Among Middle School and High School Students — United States, 2014

Jan 5th, 2016
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http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6452a3.htm?s_cid=mm6452a3_w

Abstract

Introduction:

Electronic cigarette (e-cigarette) use has increased considerably among U.S. youths since 2011. Tobacco use among youths in any form, including e-cigarettes, is unsafe. Tobacco product advertising can persuade youths to start using tobacco. CDC analyzed data from the 2014 National Youth Tobacco Survey to estimate the prevalence of e-cigarette advertisement exposure among U.S. middle school and high school students.

Methods:

The 2014 National Youth Tobacco Survey, a school-based survey of middle school and high school students in grades 6–12, included 22,007 participants. Exposure to e-cigarette advertisements (categorized as “sometimes,” “most of the time,” or “always”) was assessed for four sources: retail stores, Internet, TV and movies, and newspapers and magazines. Weighted exposure estimates were assessed overall and by school type, sex, race/ethnicity, and grade.

Results:

In 2014, 68.9% of middle and high school students (18.3 million) were exposed to e-cigarette advertisements from at least one source. Among middle school students, exposure was highest for retail stores (52.8%), followed by Internet (35.8%), TV and movies (34.1%), and newspapers and magazines (25.0%). Among high school students, exposure was highest for retail stores (56.3%), followed by Internet (42.9%), TV and movies (38.4%), and newspapers and magazines (34.6%). Among middle school students, 23.4% reported exposure to e-cigarette advertising from one source, 17.4% from two sources, 13.7% from three sources, and 11.9% from four sources. Among high school students, 21.1% reported exposure to e-cigarette advertising from one source, 17.0% from two sources, 14.5% from three sources, and 18.2% from four sources.

Conclusions and Implications for Public Health Practice:

Approximately seven in 10 U.S. middle and high school students were exposed to e-cigarette advertisements in 2014. Exposure to e-cigarette advertisements might contribute to increased use of e-cigarettes among youths. Multiple approaches are warranted to reduce youth e-cigarette use and exposure to e-cigarette advertisements, including efforts to reduce youth access to settings where tobacco products, such as e-cigarettes, are sold, and regulation of youth-oriented e-cigarette marketing.

Introduction

Electronic cigarettes (e-cigarettes) are battery-powered devices capable of delivering nicotine and other additives (e.g., flavorings) to the user in an aerosol form. E-cigarette use has increased considerably among U.S. youths in recent years. During 2011–2014, past-30-day e-cigarette use increased from 0.6% to 3.9% among middle school students and from 1.5% to 13.4% among high school students; in 2014, e-cigarettes became the most commonly used tobacco product among middle school and high school students (1). Youth use of tobacco in any form (combustible, noncombustible, or electronic) is unsafe (2,3). E-cigarettes typically deliver nicotine derived from tobacco, which is highly addictive, might harm brain development, and could lead to sustained tobacco product use among youths (2). In April 2014, the Food and Drug Administration (FDA) issued a proposed rule to deem all products made or derived from tobacco subject to FDA jurisdiction (4).

In the United States, e-cigarette sales have increased rapidly since entering the U.S. marketplace in 2007, reaching an estimated $2.5 billion in sales in 2014 (5,6). Corresponding increases have occurred in e-cigarette advertising expenditures, which increased from $6.4 million in 2011 to an estimated $115 million in 2014 (7,8). Tobacco product advertising is causally related to tobacco product initiation among youths (9). Many of the themes used in conventional tobacco product advertising, including independence, rebellion, and sexual attractiveness, also are used to advertise e-cigarettes (9,10). Moreover, almost all tobacco use begins before age 18 years, during which time there is great vulnerability to social influences, such as youth-oriented advertisements and youth-generated social media posts (9). This report assesses exposure to e-cigarette advertisements among U.S. middle school and high school students.

Methods

Data from the 2014 National Youth Tobacco Survey (NYTS) were analyzed to assess exposure to e-cigarette advertisements from four sources: retail stores (convenience stores, supermarkets, or gas stations); Internet; TV and movies; and newspapers and magazines. NYTS is a cross-sectional, school-based, self-administered, pencil-and-paper questionnaire administered to U.S. middle school (grades 6–8) and high school (grades 9–12) students.* A three-stage cluster sampling procedure was used to generate a nationally representative sample of U.S. students who attend public and private schools in grades 6–12. In 2014, 207 of 258 selected schools (80.2%) participated, yielding a sample of 22,007 participants (91.4%) among 24,084 eligible students; the overall response rate was 73.3%.

Sources of exposure to e-cigarette advertisements were assessed by participants’ responses to the following four questions: 1) Internet: “When you are using the Internet, how often do you see advertisements or promotions for electronic cigarettes or e-cigarettes?” 2) Newspapers and magazines: “When you read newspapers or magazines, how often do you see advertisements or promotions for electronic cigarettes or e-cigarettes?” 3) Retail stores: “When you go to a convenience store, supermarket, or gas station, how often do you see advertisements or promotions for electronic cigarettes or e-cigarettes?” 4) TV and movies: “When you watch TV or go to the movies, how often do you see advertisements or promotions for electronic cigarettes or e-cigarettes?” For each question, respondents could select the following options: they do not use the specific source (e.g., “I do not read newspapers or magazines”), “never,” “rarely,” “sometimes,” “most of the time,” or “always.” Respondents who said they saw promotions or advertisements “sometimes,” “most of the time,” or “always” were considered to have been exposed to advertisements from the source; those who selected “never” or “rarely” were considered not exposed. Respondents who did not use a source were also classified as not exposed.† Data were weighted to account for the complex survey design and adjusted for nonresponse. National prevalence estimates with 95% confidence intervals and population estimates were computed; population estimates were rounded down to the nearest tenth of a million. Estimates of exposure for each source were assessed overall and by school type, sex, race/ethnicity, and grade. T-tests were used to calculate differences between groups; a p-value <0.05 was considered statistically significant. The number of exposure sources were summed for each student and reported as the proportion who were exposed to one, two, three, or four sources.

Results

All students. Overall, 68.9% of participants (an estimated 18.3 million students) were exposed to e-cigarette advertisements from ≥1 source (Figure). Retail stores were the most frequently reported exposure source (54.8% of respondents, or an estimated 14.4 million students), followed by the Internet (39.8%, 10.5 million), TV and movies (36.5%, 9.6 million), and newspapers and magazines (30.4%, 8.0 million) (Table). Exposure to e-cigarette advertisements on the Internet and in newspapers and magazines was reported more frequently by females than males. Exposure in retail stores was higher among non-Hispanic whites (whites) than non-Hispanic blacks (blacks) and students of other non-Hispanic races/ethnicities. Exposure from TV and movies was higher among blacks and Hispanics than whites. Exposure was higher among students in higher grade levels for all sources. Overall, 22.1% of participants (5.8 million students) reported exposure to e-cigarette advertising from one source, 17.2% (4.5 million) from two sources, 14.1% (3.7 million) from three sources, and 15.4% (4.1 million) from four sources (Figure).

Middle school students. Among middle school students, 66.4% (7.7 million) were exposed to e-cigarette advertisements from at least one source (Figure). Retail stores were the most frequently reported source of exposure (52.8% of respondents, or an estimated 6.0 million middle school students), followed by the Internet (35.8%, 4.1 million), TV and movies (34.1%, 3.9 million), and newspapers and magazines (25.0%, 2.8 million) (Table). Exposure to e-cigarette advertisements on the Internet was higher among female than male middle school students. Exposure in retail stores was higher among whites than blacks and other non-Hispanic race/ethnicities. Exposure from TV or movies was higher among blacks than whites. A single source of exposure was reported by 23.4% of participants (2.7 million middle school students); two sources by 17.4% (2.0 million), three sources by 13.7% (1.5 million), and four sources by 11.9% (1.3 million) (Figure).

High school students. Among high school students, 70.9% of respondents (an estimated 10.5 million high school students) reported exposure to e-cigarette advertisements from at least one source (Figure). Similar to middle school students, more than half of reported e-cigarette advertising exposures (56.3%, 8.3 million) occurred in retail stores, followed by the Internet (42.9%, 6.3 million), TV and movies (38.4%, 5.6 million), and newspapers and magazines (34.6%, 5.1 million) (Table). Exposure in retail stores was higher among whites than blacks and other non-Hispanic race/ethnicities. Exposure from TV and movies was higher among blacks than whites. One source of exposure was reported by 21.1% of participants (3.1 million high school students), two sources by 17.0% (2.5 million), three sources by 14.5% (2.1 million), and four sources by 18.2% (2.7 million) (Figure).

Conclusions and Comments

In 2014, nearly seven in 10 (18.3 million) U.S. middle school and high school students were exposed to e-cigarette advertisements from at least one source, and approximately 15%, or 4.1 million students, were exposed to e-cigarette advertisements from all four sources. Approximately half were exposed to e-cigarette advertisements in retail stores, whereas approximately one in three were exposed on the Internet, on TV or at the movies, or while reading newspapers or magazines. Although there were slight variations by sex and race/ethnicity, the magnitude of exposure was consistent across groups. Implementation of comprehensive efforts to reduce youth exposure to e-cigarette advertising and promotion is critical to reduce e-cigarette experimentation and use among youths.

Retail store exposure to e-cigarette advertising in this study (54.8%) was lower than levels of exposure to conventional cigarette and other tobacco product advertising reported in the NYTS in 2014 (80.6%), but comparable to exposure on the Internet (39.8% versus 46.8%, respectively) and in newspapers and magazines (30.4% versus 34.3%, respectively) (11).§ Advertising for conventional tobacco products, such as cigarettes, has been shown to prompt experimentation as well as increase and maintain tobacco product use among youths (9). Similarly, according to a recent randomized controlled study, adolescents who were exposed to e-cigarette advertisements on TV were 54% more likely to say they would try an e-cigarette soon, and 43% more likely to say they would try an e-cigarette within the next year, compared with adolescents who were not exposed to e-cigarette advertisements (12). The study also determined that youths exposed to e-cigarette advertisements were more likely to agree that e-cigarettes can be used in places where smoking is not allowed (12). This is consistent with findings that certain e-cigarette marketers are using advertising tactics similar to those used in the past to market conventional cigarettes, including youth-oriented themes, and promoting e-cigarette use as an alternative in places where smoking is not allowed (2,9,10). An analysis of 57 online e-cigarette vendors determined that 70.2% of vendors used more than one social network service to market e-cigarettes (13). Moreover, 61.4% of vendors only required users to click a pop-up or dialog box to self-verify age, and 35.1% of vendors had no detectable age verification process. This unrestricted marketing of e-cigarettes, coupled with rising use of these products among youths (1), has the potential to compromise decades of progress in preventing tobacco use and promoting a tobacco-free lifestyle among youths (2,9).

Research supports the importance of a multifaceted approach to youth tobacco prevention involving multiple levels of government (2,9,14). Local, state, and federal efforts to reduce youth access to the settings where tobacco products, including e-cigarettes, are sold could reduce youth e-cigarette initiation and consumption, as well as advertising exposure. Potential strategies include requiring that tobacco products, including e-cigarettes, be sold only in facilities that never admit youths; limiting tobacco outlet density or proximity to schools; and requiring that e-cigarette purchases be made only through face-to-face transactions. Adding e-cigarettes and other tobacco products to the list of current tobacco products prohibited from being sent through U.S. mail and requiring age verification for online sales at purchase and delivery could also prevent sales to youths. In addition, potential strategies at the federal or state level include regulation of e-cigarette advertising in media, Internet, and retail settings that are demonstrated to appeal to youths or are viewed by a substantial number of youths. The evidence base for restricting advertisements for conventional tobacco products indicates that these interventions would be expected to contribute to reductions in e-cigarette advertisement exposure and use among youths as well (2,9). To effectively implement these strategies, there is a need for fully funded and sustained comprehensive state tobacco control programs that address all forms of tobacco use, including e-cigarettes (14). These programs are critical to support the implementation and maintenance of proven population-based interventions to reduce tobacco use among youths, including tobacco price increases, comprehensive smoke-free laws, and high impact mass media campaigns (14). However, in 2015, states appropriated only 1.9% ($490.4 million) of combined revenues of $25.6 billion from settlement payments and tobacco taxes for all states on comprehensive tobacco control programs,¶ representing <15% of the CDC-recommended level of funding ($3.3 billion) for all states combined (14). Only two states (Alaska and North Dakota) currently fund tobacco control programs at CDC-recommended levels. Additionally, parents, caregivers, and health care providers can talk to children about the dangers of tobacco use, encourage or set limits on media use, and teach children critical media viewing skills to increase their resistance to pro-tobacco messages (15).

These findings are subject to at least three limitations. First, advertising exposure was self-reported and is subject to recall bias. Second, data were collected only from students who attended public or private schools and might not be generalizable to middle school- and high school-aged youths who are being homeschooled, youths who have dropped out of school, or youths in detention centers. However, data from the Current Population Survey indicate that 97.5% of U.S. youths aged 10–13 years and 95.4% of those aged 14–17 years were enrolled in a traditional school in 2014.** Finally, exposure to e-cigarette advertisements might have been underestimated, as survey questions asked only about exposure from four sources, and did not assess exposure from other potential sources such as sporting events, radio, or billboards.

This report highlights youth exposure to e-cigarette advertisements, which might be contributing to increasing youth experimentation with and use of e-cigarettes in recent years. Multiple approaches are warranted to reduce youth e-cigarette use and exposure to e-cigarette advertisements, including efforts to reduce youth access to the settings where tobacco products, including e-cigarettes, are sold, and regulation of youth-oriented e-cigarette marketing. The implementation of these approaches, in coordination with fully funded and sustained comprehensive state tobacco control programs, has the potential to reduce all forms of tobacco use among youths, including e-cigarette use.

E-cigarette Ads and Youth

Jan 5th, 2016
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E-cigarette ads entice U.S. youth, could undo tobacco prevention efforts -CDC

Jan 5th, 2016
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http://www.reuters.com/article/usa-ecigarettes-idUSL1N14P13P20160105

E-cigarette companies are reaching about seven in 10 U.S. middle- and high-school students with advertisements employing themes of sex, independence and rebellion that hooked previous generations on regular cigarettes, a government study released on Tuesday said.

The marketing strategy could reverse decades of progress in preventing tobacco use among youth, warned the U.S. Centers for Disease Control and Prevention, which suggested tighter controls on e-cigarette sales to reduce minors’ access.

“The same advertising tactics the tobacco industry used years ago to get kids addicted to nicotine are now being used to entice a new generation of young people to use e-cigarettes,” said CDC Director Tom Frieden.

The CDC’s National Youth Tobacco Survey found that 68.9 percent of middle- and high-school students saw e-cigarette ads from one or more media sources in 2014, most commonly in stores but also online, on television and in movies or magazines.

E-cigarette use among this age group soared over the past five years, surpassing its use of regular cigarettes in 2014, according to CDC statistics. Spending on e-cigarette advertising also jumped, increasing to an estimated $115 million in 2014 from $6.4 million in 2011.

E-cigarettes contain cartridges that typically hold nicotine as well as other liquids and flavorings, and a heating element to create a vapor that the user inhales.

Many researchers believe e-cigarettes are less harmful than regular cigarettes, but the risks are still being studied.

“Youth use of tobacco in any form (combustible, noncombustible or electronic) is unsafe,” the CDC study said.

Exposure to tobacco at a young age may cause addiction and lasting harm to brain development, the agency reported.

Most states have passed laws banning the sale of e-cigarettes to minors, and the U.S. Food and Drug Administration’s proposal to regulate the products is under federal review. (Reporting by Barbara Liston in Orlando, Fla.; Editing by Colleen Jenkins and Lisa Von Ahn)

CDC: Youth exposure to electronic cigarettes ads contributing to use

Jan 5th, 2016
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http://wtop.com/health/2016/01/cdc-youth-exposure-to-e-cig-ads-contributing-to-use/

WASHINGTON — Children in the United States are seeing lots of ads for e-cigarettes — and the Centers for Disease Control and Prevention says that is one big reason why the use of e-cigs is soaring among the young.

A new CDC report says seven in 10 middle and high school students have seen these advertisements which — like cigarette ads of yore — use themes of sex, independence and rebellion to sell their products.

“The e-cigarette advertising we’re seeing is like the old-time Wild West; no rules, no regulations and heavy spending,” says CDC Director Tom Frieden.

Data from the CDC’s 2014 National Youth Tobacco Survey, found that 68.9 percent of teens and tweens saw e-cigarette ads from one or more media source. And those advertisements can have a great impact.

“Kids just pick up advertising messages really well and from young ages,” says Joanna Cohen, director of the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health.

She cites a key study conducted in the 1990s to prove her point. It showed that children as young as 3 years old recognized the Joe Camel cartoon figure more than they recognized Mickey Mouse.

Last year, researchers at Hopkins wrote of the potential health hazards of e-cigarettes. The report — published in the journal PLOS ONE — was based on a mouse study that found evidence that e-cigs may compromise the immune system.

Frieden says while there may be some limited benefit to short-term e-cigarette use for adults trying to wean themselves off regular cigarettes, the risk for kids is unacceptable.

He cites a possible impact on brain development, and notes that e-cigs still contain nicotine, which can be extremely addictive.

Government statistics show while cigarette smoking is down among teens, the use of e-cigs is way up. The CDC says e-cigarettes could reverse the trend, with many young people eventually transitioning to far more dangerous tobacco products.

“We are really excited that smoking rates are coming down among kids, but we have to keep working to make sure that they stay low,” says Cohen.

Maryland and Virginia are among the states that have already banned sales of e-cigarettes to minors, and similar legislation has been introduced in the District, but there has been no movement in the D.C. council.

But it may take much more than a ban to solve the problem, Frieden says.

E-cigarettes are readily available for anyone of any age to purchase on the Internet, and the CDC’s Frieden indicates an all-out awareness campaign may be needed.

He suggests states may want to use some of the money they received as part of a big settlement with tobacco companies in the late 1990s. But such action may have to wait until the Food And Drug Administration announces a long-awaited formal proposal to regulate e-cigarettes as a tobacco product.

Health agency takes on advertising for electronic cigarettes

Jan 5th, 2016
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http://6abc.com/health/health-agency-takes-on-advertising-for-electronic-cigarettes/1147363/

The nation’s lead public health agency is focusing its attack on electronic cigarettes on the issue of advertising, saying too many kids see the ads.

The Centers for Disease Control and Prevention released national survey results Tuesday indicating 7 in 10 youths see e-cigarette ads, mostly in stores.

CDC officials worry such ads will lead more kids to try them and, perhaps, regular cigarettes.

The report says the e-cigarette ads use many of the same themes used to sell tobacco cigarettes and other tobacco products.

CDC Director Dr. Tom Frieden says, “The same advertising tactics the tobacco industry used years ago to get kids addicted to nicotine are now being used to entire a new generation of young people to use e-cigarettes.”

In 2014, e-cigarettes became the most commonly used tobacco product among young people, surpassing tobacco products.

Ad spending on electronic cigarettes has risen from $6.4 million in 2011 to an estimated US$115 million in 2014.

There are bans on TV commercials and some other types of marketing for regular cigarettes but there are no restrictions on advertisements for e-cigarettes. Most states, though, ban the sale of e-cigarettes to minors.

The report doesn’t prove advertising is actually causing more kids to pick up e-cigarettes and a trade group said the survey is flawed

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