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January 5th, 2016:

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

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

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

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

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

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

Tobacco Giants Eye Lucrative $50 Billion Marijuana Market

http://thelibertarianrepublic.com/tobacco-giants-eye-lucrative-50-billion-marijuana-market/

Big tobacco is positioning itself to muscle into the growing marijuana business if the drug wins nationwide legal status, according to a Daily Caller News Foundation investigation.

Four states and the District of Columbia have already approved some level of legalization for possession of small amounts of marijuana, and 10 other states may have ballot measures in 2016 that give voters further opportunities to legalize possession.

Big tobacco, despite its conservative image since the 1970s, has been closely eyeing the marijuana market which venture capitalists regard to be worth $50 billion in annual revenues.

Tobacco companies are now on a buying spree of e-cigarette companies — the producers of smoking devices called vaporizers marijuana users prefer because vaporization can offer a higher high.

In 1970, Philip Morris covertly sought government research funds from the Department of Justice (DOJ), then overseen by Attorney General John N. Mitchell, a close friend and ally of President Richard Nixon. The funds were to be used to study the drug, according to documents obtained under litigation by the University of California, San Francisco (UCSF).

After approaching DOJ’s Bureau of Narcotics and Drug Abuse with a secret offer to conduct marijuana research, Philip Morris received formal bureau approval, although the company insisted it be done on a “confidential basis” to avoid public awareness.

“We can hardly refuse this request under any circumstances,” stated an unsigned 1970 Philip Morris memo to executives obtained by UCSF’s Center for Tobacco Research & Education.

“We are in the business of relaxing people who are tense and providing a pick up for people who are bored or depressed,” the tobacco memo added. “The human needs that our product fills will not go away. Thus, the only real threat to our business is that society will find other means of satisfying these needs.”

Philip Morris, now known as Altria, was so enthusiastic over the prospects of cashing in on marijuana that in 1993 it sought the French trademark and intellectual property rights for the name “Marley,” named after Jamaican celebrity Bob Marley, an avid and well-known advocate for the drug.

Reynolds America’s Jacob McConnico told TheDCNF there are no marijuana plans underway at his tobacco company. “None of Reynolds American’s operating companies is evaluating entering the U.S. market with commercial brands of marijuana,” he said.

Altria did not respond to TheDCNF’s request for comment.

“I would deny it, too,” replied Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford School of Medicine. “If that were my intention, I would deny it at this moment,” he told TheDCNF.

Humphreys is a giant in the drug abuse and reform movement. He sat on California’s highly publicized “blue ribbon” marijuana policy commission as a steering committee member that was headed by California’s pro-legalization Democratic Lt. Governor Gavin Newsom. Humphreys was also a senior advisor to Obama at the White House Office of Drug Control Policy.

Humphreys said big tobacco has a distinct advantage in marijuana production. “On marijuana, who knows better how to grow a plant that you dry up, wrap up in paper and smoke,” he told TheDCNF. “They’re the masters of that worldwide and have wide brand recognition.”

Jonathan Caulkins, a professor at Carnegie Mellon University’s Heinz Center and co-director of RAND’s Drug Policy Center, told TheDCNF he believes the tobacco industry is privately looking at the legalization movement.

“If you’re specifically in the tobacco industry, of course you should be paying great attention,” Caulkins said. “It would be unfair to your shareholders if you didn’t at least watch with interest and probably should have several analysts working full time trying to think of different scenarios of how this could play out,” he said.

Dr. Stanton Glantz of the UCSF School of Medicine and the American Legacy Foundation Distinguished Professor of Tobacco Control told TheDCNF, “They certainly would deny it if you asked them, but the reality is that tobacco firms are very well positioned.”

“They know how to make the product very well and very efficiently,” Glantz said. “More important, they know how to engineer the product to maximize the addictive potential, which is something that the current marijuana enterprises probably aren’t as good at.”

Glantz, who was also a key figure in the litigation effort that released 80 million pages of internal tobacco industry documents, said “it would be a very, very very small step for them to dive into the marijuana with both feet if they wanted to.”

The documents show big tobacco has toyed with marijuana cigarettes for at least a half a century.

“Since at least 1970, despite fervent denials, three multinational tobacco companies, Phillip Morris (PM), British American Tobacco (BAT, including its US subsidiary Brown & Williamson [B&W]), and RJ Reynolds (RJR), all have considered manufacturing cigarettes containing cannabis,” the UCSF researchers concluded.

Glantz asserted tobacco companies “have the financial resources, product design technology to optimize puff-by-puff delivery of a psychoactive drug (nicotine), marketing muscle, and political clout to transform the marijuana market.”

As noted previously, big tobacco is also buying up American e-cigarette companies with fervor. The devices called vaporizers can be used with either tobacco or marijuana.

In the last three years, Altria Group acquired e-cigarette company Green Smoke for $110 million and Lorillard acquired Blu Ecigs for $135 million and Reynolds America launched its own e-cigarette vaporizing brand, called Vuse.

Last April, Japan American Tobacco agreed to acquire Logic Technology Development, LLC, the third largest e-cigarette company offered in American convenience stores.

“For e-cigarettes, there is a huge crossover in e-cigarette use between marijuana and tobacco,” Glantz told TheDCNF.

A 2003 University of Florida study found that two out of three marijuana users follow the drug with mentholated cigarettes, which can extend the high.

Caulkins said he believes “it will be quite possible in the marijuana legalization market, we might move away from combustion-related products and moving heavily into ‘vaping’ based products.