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Czaplicki L, Barker HE, Thrul J, Cui Y, Yang T, Cohen JE. Quantifying Cigarette and e-Cigarette Marketing Exposure Among Chinese Adolescents Using Ecological Momentary Assessment. Nicotine Tob Res 2024; 26:1480-1488. [PMID: 38695345 PMCID: PMC11494615 DOI: 10.1093/ntr/ntae103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 10/23/2024]
Abstract
INTRODUCTION Addressing cigarette and e-cigarette use in China is key to reducing the global tobacco epidemic. Marketing exposure is one causal factor for adolescent smoking and e-cigarette use. Currently, China restricts cigarette and e-cigarette ads in public places and online; however, there may not be full policy compliance. We collected real-time data in the natural environment to estimate how much and where Chinese adolescents-a group susceptible to smoking and e-cigarette use-are exposed to cigarette and e-cigarette marketing to inform policy responses. AIMS AND METHODS In June 2022, we conducted a 7-day ecological momentary assessment (EMA) study with 15-16-year-olds (n = 96) across eight Chinese cities. Participants completed up to 42 EMA surveys (six per day), sent at random intervals outside of school hours. In each survey, participants reported whether they saw (1) displays and (2) ads in the past hour (none, cigarette, e-cigarette, both) in the past hour. We also captured the source of cigarette/e-cigarette ad exposure. RESULTS Most participants were exposed to cigarette and/or e-cigarette displays (89.6%) or ads (79.2%) more than 7 days. On average, participants reported past-hour exposure to displays 12.7 times and past-hour exposure to ads 10.8 times over the week. The most common sources of cigarette ads were public places (eg, kiosks, supermarkets); the most common sources of e-cigarette ad exposure were social media/internet or e-cigarette stores. CONCLUSIONS Findings highlight the need to enhance enforcement of restrictions on cigarette and e-cigarette ads in public places and online in China and extend restrictions to ban displays. IMPLICATIONS Marketing exposure is a causal factor in youth smoking and e-cigarette use. We used EMA to estimate cigarette and e-cigarette display and ad exposure among Chinese adolescents. On average, participants reported past-hour exposure to cigarette and/or e-cigarette displays 13 times and past-hour exposure to cigarette and/or e-cigarette ads 11 times more than 1 week. Most saw ads in public places and online. Results suggest strengthening implementation of China's ban on cigarette and e-cigarette ads in public places and online and banning product displays. These are policy responses that can contribute to reducing adolescent cigarette and e-cigarette uptake in China.
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Affiliation(s)
- Lauren Czaplicki
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hannah E Barker
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Yuxian Cui
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tingzhong Yang
- Center for Tobacco Control Research/Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Whitton C, Wong YHM, Lau J, Chua XH, Müller AM, Tan CS, van Dam RM, Müller-Riemenschneider F, Rebello SA. Ecological momentary assessment of digital food and beverage marketing exposure and impact in young adults: A feasibility study. Appetite 2024; 197:107338. [PMID: 38579981 DOI: 10.1016/j.appet.2024.107338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/13/2024] [Accepted: 04/02/2024] [Indexed: 04/07/2024]
Abstract
Unhealthy food marketing is contributing to the obesity epidemic, but real-time insights into the mechanisms of this relationship are under-studied. Digital marketing is growing and following food and beverage (F&B) brands on social media is common, but measurement of exposure and impact of such marketing presents novel challenges. Thus, this study aimed to evaluate the feasibility of collecting data on exposure and impact of digital F&B marketing (DFM) using a smartphone-based ecological momentary assessment (EMA) methodology. We hypothesized that DFM-induced food cravings would vary based on whether (or not) participants engaged with F&B brands online. Participants were Singapore residents (n = 95, 21-40 years), recruited via telephone from an existing cohort. Participants were asked to upload screenshots of all sightings of online F&B marketing messages for seven days, and answer in-app contextual questions about sightings including whether any cravings were induced. Participants provided a total of 1310 uploads (median 9 per participant, Q1-Q3: 4-21) of F&B marketing messages, 27% of which were provided on Day 1, significantly more than on other days (P < 0.001). Followers of food/beverage brands on social media encountered 25.6 percentage points (95% CI 11.4, 39.7) more marketing messages that induced cravings than participants who were not followers. University education was also associated with more (18.1 percentage points; 95% CI 3.1, 33.1) encounters with marketing messages that induced cravings. It was practical and acceptable to participants to gather insights into digital F&B marketing exposure and impact using EMA in young adults, although a shorter study period is recommended in future studies. Followers of food and beverage brands on social media appear to be more prone to experience cravings after exposure to digital F&B marketing.
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Affiliation(s)
- Clare Whitton
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Yvonne Hui Min Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jerrald Lau
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xin Hui Chua
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; Department of Nutrition and Exercise Sciences and Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; Digital Health Center, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Salome A Rebello
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
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Noël C, Scharf D, Koné A, Armiento C, Dylan D. Cannabis advertising impacts on youth cannabis use intentions following recreational legalization in Canada: An Ecological Momentary Assessment (EMA) study. Addict Behav 2024; 153:107981. [PMID: 38367505 DOI: 10.1016/j.addbeh.2024.107981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE In 2018, Canada's Cannabis Act legalized adult recreational cannabis use and limited cannabis product advertising to adults. Cannabis product advertising to youth remains illegal. The extent to which adult-targeted, or illicit youth-targeted cannabis advertisements is reaching and impacting Canadian youth is unknown. We used Ecological Momentary Assessment (EMA) to describe how often and how much exposures to cannabis advertising influence Canadian youths' real-world, real-time intentions to use cannabis. METHODS 120 Ontario, Canada youths ages 14-18, took photos of cannabis advertising that they encountered in their natural environments over a period of nine consecutive days. Following each exposure and twice daily device-issued random prompts, they also rated their intentions to use cannabis. RESULTS Many participating youth (n = 85; 70.83 %) reported at least one cannabis advertising exposure during the study (range 1-30, M = 4.02). Exposures occurred through a range of advertising channels (e.g., internet ads, billboards). Multilevel modeling showed that youth advertising exposure increased cannabis use intentions in vivo (β = 0.06,SE = 0.03;t = 1.98;p =.04;n = 1,348). CONCLUSION Data from this study shows that cannabis advertisements are regularly reaching Canadian youth and increasing their intentions to use cannabis. This suggests that current Canadian prohibitions on cannabis advertising to youth are ineffective and/or ineffectively enforced, and that the Canadian government needs additional or enhanced prohibitions on cannabis promotion to protect youth from harms associated with increased advertisement exposure, such as increased cannabis use.
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Affiliation(s)
- Chelsea Noël
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Deborah Scharf
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada; Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada.
| | - Anna Koné
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | | | - Daniel Dylan
- Bora Laskin Faculty of Law, Lakehead University, Thunder Bay, Ontario, Canada
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Andrews M, Cooper N, Mattan BD, Carreras-Tartak J, Paul AM, Strasser AA, Henriksen L, Falk EB. Causal effects of point-of-sale cigarette promotions and subjective social status on cigarette craving: a randomised within-person experiment. Tob Control 2023:tc-2023-058069. [PMID: 37949653 PMCID: PMC11082063 DOI: 10.1136/tc-2023-058069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Cigarette smoking continues to be a leading cause of preventable deaths in the USA, in part because the USA has not adopted the WHO Framework Convention on Tobacco Control. One way the tobacco industry counteracts tobacco control policies is by heavily advertising cigarettes at the point of sale in retailers (eg, at the cash register) and by offering discounts on cigarettes. DESIGN A within-subject experimental design with adults who smoke cigarettes daily (n=281) investigated whether: (1) exposure to images of cigarette promotions in an online experiment is associated with greater cigarette craving relative to viewing images of non-smoking cues, and (2) if exposure to images of point-of-sale cigarette promotions with a discount (vs without) increases cigarette craving. The study also examined how participants' subjective social status (compared with others in the USA) relates to cigarette craving after exposure to images of cigarette promotions with and without a discount. RESULTS In an online experiment, exposure to images of smoking cues, including point-of-sale cigarette promotions, elicited greater craving relative to non-smoking cues (all p<0.001). In addition, images of promotions with a discount elicited higher levels of craving compared with those without a discount (b=0.09, p=0.001). Although participants with a higher (vs lower) subjective social status craved cigarettes less overall (b=-0.12, p=0.012), there was no difference in their craving between images of promotions with and without a discount, while craving was higher for images of promotions with a discount than without for participants with higher subjective social status (b=0.06, p=0.021). CONCLUSION Viewing images of point-of-sale cigarette promotions can causally increase cravings to smoke, which may also apply to real-world retail settings that display cigarette promotions. Restricting point-of-sale promotions generally, and discounts specifically, could help reduce cigarette smoking and address tobacco use disparities in the USA.
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Affiliation(s)
- Mary Andrews
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicole Cooper
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bradley D Mattan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - José Carreras-Tartak
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexandra M Paul
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew A Strasser
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Emily B Falk
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Wharton Marketing Department, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Nam HK, Kim H, Chun HR, Kang H. Association between tobacco industry advertising expenses and tobacco advertising exposure among Korean adolescents. BMJ Open 2023; 13:e073078. [PMID: 37813537 PMCID: PMC10565145 DOI: 10.1136/bmjopen-2023-073078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION Monitoring the activities and impacts of tobacco industries is vital for tobacco control. Based on tobacco industry financial statements and a nationally representative survey of Korean adolescents, we examined the association between tobacco industry commercial advertising expenses and advertising exposure among Korean adolescents. METHODS The commercial advertising expenses of three major tobacco industries in Korea (KT&G, Philip Morris Korea, and British and American Tobacco Korea) were identified in a repository (Data Analysis Retrieval and Transfer System) established by the Korean Financial Supervisory Service. The yearly advertising expenses were merged with data from the Korean Youth Risk Behavior Survey (2015-2018 and 2021, total N=309 190). We used logistic regression analyses to analyse the associations between tobacco industry advertising expenses and adolescent tobacco advertisement exposure. RESULTS In 2021, the total advertising expenses of the three companies exceeded US$260 million, and the proportion of Korean adolescents exposed to tobacco advertisements ranged from 65.9% to 78.7% during 2015-2018 and 2021. Higher advertising expense sizes were associated with the risk of exposure to tobacco advertisements in both girls and boys, with OR of 1.009 (95% CI (1): 1.008 to 1.010) and 1.010 (95% CI: 1.009 to 1.011), respectively. CONCLUSION Tobacco industry advertising expenses are associated with tobacco marketing exposure among adolescents. We used financial data to identify the reach of tobacco advertising among Korean adolescents. It is essential to increase tobacco industry surveillance using various data sources and to regulate tobacco advertising more strongly.
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Affiliation(s)
- Hee-Kyoung Nam
- Department of Public Health Science, Seoul National University, Seoul, Republic of Korea
| | - Hana Kim
- Department of Public Health Science, Seoul National University, Seoul, Republic of Korea
| | - Hae-Ryoung Chun
- Department of Public Health Science, Seoul National University, Seoul, Republic of Korea
| | - Heewon Kang
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
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Murray A, Ushakova A, Zhu X, Yang Y, Xiao Z, Brown R, Speyer L, Ribeaud D, Eisner M. Predicting Participation Willingness in Ecological Momentary Assessment of General Population Health and Behavior: Machine Learning Study. J Med Internet Res 2023; 25:e41412. [PMID: 37531181 PMCID: PMC10433031 DOI: 10.2196/41412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 03/07/2023] [Accepted: 03/21/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Ecological momentary assessment (EMA) is widely used in health research to capture individuals' experiences in the flow of daily life. The majority of EMA studies, however, rely on nonprobability sampling approaches, leaving open the possibility of nonrandom participation concerning the individual characteristics of interest in EMA research. Knowledge of the factors that predict participation in EMA research is required to evaluate this possibility and can also inform optimal recruitment strategies. OBJECTIVE This study aimed to examine the extent to which being willing to participate in EMA research is related to respondent characteristics and to identify the most critical predictors of participation. METHODS We leveraged the availability of comprehensive data on a general young adult population pool of potential EMA participants and used and compared logistic regression, classification and regression trees, and random forest approaches to evaluate respondents' characteristic predictors of willingness to participate in the Decades-to-Minutes EMA study. RESULTS In unadjusted logistic regression models, gender, migration background, anxiety, attention deficit hyperactivity disorder symptoms, stress, and prosociality were significant predictors of participation willingness; in logistic regression models, mutually adjusting for all predictors, migration background, tobacco use, and social exclusion were significant predictors. Tree-based approaches also identified migration status, tobacco use, and prosociality as prominent predictors. However, overall, willingness to participate in the Decades-to-Minutes EMA study was only weakly predictable from respondent characteristics. Cross-validation areas under the curve for the best models were only in the range of 0.56 to 0.57. CONCLUSIONS Results suggest that migration background is the single most promising target for improving EMA participation and sample representativeness; however, more research is needed to improve prediction of participation in EMA studies in health.
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Affiliation(s)
- Aja Murray
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Anastasia Ushakova
- Centre for Health Informatics, Lancaster University, Lancaster, United Kingdom
| | - Xinxin Zhu
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Yi Yang
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Zhuoni Xiao
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Ruth Brown
- Clinical Psychology Department, University of Edinburgh, Edinburgh, United Kingdom
| | - Lydia Speyer
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Denis Ribeaud
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Manuel Eisner
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
- Institute of Criminology, University of Cambridge, Cambridge, United Kingdom
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Hébert ET, Vandewater EA, Businelle MS, Harrell MB, Kelder SH, Perry CL. Tobacco advertising exposure and product use among young adults: An ecological momentary assessment approach. Addict Behav 2023; 139:107601. [PMID: 36592525 PMCID: PMC9872832 DOI: 10.1016/j.addbeh.2022.107601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Tobacco-related content is prevalent on social media, yet many methods of measuring exposure are inadequate due to the personalized nature of online marketing. The purpose of this paper is to examine the association between exposure to pro-tobacco messages (both industry-sponsored and user-generated) and the use of tobacco products, as reported via ecological momentary assessment (EMA). METHODS Young adults (n = 175) were instructed to record all sightings of marketing (both in-person and online) related to tobacco for 28 days. Tobacco product use and recall of message encounters were assessed daily using app-initiated EMA. RESULTS Participants who reported exposure to tobacco messages were significantly more likely to report using tobacco, adjusting for gender, age, race/ethnicity, baseline use of any tobacco product, and having friends who use tobacco and e-cigarettes (p <.001). For each industry-sponsored message viewed, the odds of using tobacco or e-cigarettes in a given day increased by a factor of 1.77 (95 % CI = 1.41, 2.23). For each user-generated message viewed, the odds of using tobacco or e-cigarettes in a given day increased by a factor of 1.52 (95 % CI = 1.27, 1.83). DISCUSSION To our knowledge, this is the first study to specifically examine the association between exposure to user-generated messages and daily tobacco use. The findings suggests that there is a unique element to user-generated messages that distinguishes them from both traditional marketing and from simple peer influence.
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Affiliation(s)
- Emily T Hébert
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, United States.
| | | | - Michael S Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Melissa B Harrell
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, United States
| | - Steven H Kelder
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, United States
| | - Cheryl L Perry
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, United States
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Medvescek K, Allen AM. Feasibility of Remotely Assessing Hormonal Contraceptive Use and Smoking-Related Symptomatology: Evidence from a Preliminary Prospective Cohort Study. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100145. [PMID: 37009029 PMCID: PMC10060171 DOI: 10.1016/j.dadr.2023.100145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Abstract
Background Half of women who smoke cigarettes also use hormonal contraceptives (HCs). Prior research suggests that variations in ovarian hormones may undermine smoking cessation efforts made by premenopausal women. However, clinical findings of these hormonal effects are inconsistent, potentially due to methodological limitations. The goal of this preliminary prospective cohort study is to determine the feasibility and acceptability of a fully remote protocol to longitudinally examine changes in smoking-related behavior and symptoms in relation to hormone use in women of reproductive age. Methods Eligible participants (n = 60) were biologically female, current age 18-35 years old, smokes ≥ 5 cigarettes/day, and classified into three groups: naturally-cycling (NC; n = 17), using a monophasic oral contraceptive (OC; n = 21), or using depot medroxyprogesterone acetate (DMPA; n = 22). Participants completed daily surveys and weekly dried blood spot collections. Results Overall, 92% (55/60) participants completed the study with 90% of daily surveys completed and 87% of participants collecting at least 5 of the 6 dried blood spot samples. Participants were "somewhat" (13%) or "extremely" (87%) likely to participate in the study again. Preliminary observations also suggested differences in self-reported cigarettes/day and premenstrual pain over time by study group. Conclusions This study outlines a fully remote protocol that may be used to clarify the relationships between hormonal contraceptive use and smoking-related outcomes over time. Preliminary results add to existing evidence that HC use may reduce relapse risk for premenopausal women.
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Venrick SJ, Kelley DE, O'Brien E, Margolis KA, Navarro MA, Alexander JP, O'Donnell AN. U.S. digital tobacco marketing and youth: A narrative review. Prev Med Rep 2023; 31:102094. [PMID: 36820374 PMCID: PMC9938337 DOI: 10.1016/j.pmedr.2022.102094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/12/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
We describe findings from peer-reviewed articles on digital tobacco marketing (DTM) using U.S. data related to youth, including research that examines use of age restrictions, DTM exposure and engagement, and associated tobacco use. We searched PubMed, EMBASE, Web of Science, and EBSCOhost in May 2019 and May 2020 for published English language peer-reviewed articles examining DTM that were published from January 2016 to May 2020. Inclusion coding occurred in three stages. The first search identified 519 articles; 167 were coded for inclusion. The second search identified 189 articles; 67 were coded for inclusion. Two coders then assessed whether the included articles mentioned youth (age 18 and younger) or age restrictions in the method and results sections of the full text. Ultimately, 47 articles were included in this review. A codebook was developed and tested through training. Each article was coded for age restrictions, youth exposure to DTM, youth engagement with DTM, and youth tobacco use associated with DTM exposure or engagement. The studies reviewed indicate that DTM on social media was infrequently age-restricted and the stringency of age restriction varied by tobacco product, site owner, and channel. Youth reported being exposed to DTM frequently via the Internet. While youth reported less frequently engaging with DTM compared to being exposed, engagement increased over time. DTM exposure and engagement were associated with tobacco product use. The studies reviewed document an association between DTM exposure and engagement and future tobacco use; thus, DTM may be contributing to the youth tobacco epidemic.
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Affiliation(s)
- Samantha J. Venrick
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States
| | - Dannielle E. Kelley
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States
| | - Erin O'Brien
- US Food and Drug Administration, Center for Tobacco Products, Office of Health Communication and Education, Silver Spring, MD, United States
| | - Katherine A. Margolis
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States
| | - Mario A. Navarro
- US Food and Drug Administration, Center for Tobacco Products, Office of Health Communication and Education, Silver Spring, MD, United States
| | - Jennifer P. Alexander
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States
| | - Allison N. O'Donnell
- US Food and Drug Administration, Center for Tobacco Products, Office of Health Communication and Education, Silver Spring, MD, United States
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Abadi MH, Shamblen SR, Thompson K, Lipperman-Kreda S, Grube J, Richard BO, Aramburu C. Socio-temporal contextual and community factors associated with daily exclusive ENDS use and dual use with tobacco cigarettes among adolescent vapers: an ecological momentary assessment study. BMC Public Health 2022; 22:2289. [PMID: 36474234 PMCID: PMC9728002 DOI: 10.1186/s12889-022-14787-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Adolescents who dual use ENDS with tobacco cigarettes are more likely to have an increased risk of developing dependence. Yet, little is understood about the factors driving dual use among adolescents. The current study sought to reveal the day-to-day socio-temporal contextual and community factors associated with adolescents' use of electronic nicotine delivery systems (ENDS), and how these factors predict dual use with tobacco cigarettes. METHODS We collected ecological momentary assessments (EMA) from a sample of 50 adolescent past two-week vapers (ages 14-17 years old) over 14 days. Daily EMA data were collected on ENDS and tobacco cigarette use, as well as a range of contextual (i.e., motivations to vape, location of vaping, who with when vaping) and community factors (i.e., exposure to peers vaping, to adults vaping, to ENDS advertising, to ENDS warning messages). Our primary analyses were multilevel regressions, accounting for daily observations nested within individuals (N = 700 observations). RESULTS Participants used ENDS exclusively on 44% of days and dual used ENDS and tobacco cigarettes on 8% of the days. Dual use days (versus exclusive ENDS use days) were associated with "vaping because tobacco use was prohibited" (OR = 34.65, p < .05). Also, dual use days (versus no use days) were associated with greater exposure to adults vaping (OR = 5.59, p < .05), peers vaping (OR = 7.48, p < .05), and (c) ENDS advertisements or promotions (OR = 2.12, p < .01), whereas exclusive use days (versus no use days) were only associated with greater exposure to peers vaping (OR = 2.58, p < .01). CONCLUSIONS Results showed that exposure to peers and adults vaping and exposure to ENDS marketing were associated with same day dual use behaviors. And, that adolescents who dual used were motivated to use ENDS because they were easy to conceal. Findings support stricter regulation of ENDS marketing and for smoke-free air laws that include ENDS. In addition, these findings support prioritizing family- and school-based prevention programming that effectively communicates risk associated with ENDS use, including heightened risk of dual use and dependence. Such efforts can reduce the number of adolescents who use ENDS as well as the number who transition to tobacco cigarette use.
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Affiliation(s)
- Melissa H. Abadi
- grid.280247.b0000 0000 9994 4271Pacific Institute for Research and Evaluation, 401 West Main Street, Suite 2100, Louisville, KY 40202 USA
| | - Stephen R. Shamblen
- grid.280247.b0000 0000 9994 4271Pacific Institute for Research and Evaluation, 401 West Main Street, Suite 2100, Louisville, KY 40202 USA
| | - Kirsten Thompson
- grid.280247.b0000 0000 9994 4271Pacific Institute for Research and Evaluation, 401 West Main Street, Suite 2100, Louisville, KY 40202 USA
| | - Sharon Lipperman-Kreda
- grid.47840.3f0000 0001 2181 7878Prevention Research Center, Pacific Institute for Research and Evaluation, 2030 Addison Street, Suite 410, Berkeley, CA 94704-2642 USA
| | - Joel Grube
- grid.47840.3f0000 0001 2181 7878Prevention Research Center, Pacific Institute for Research and Evaluation, 2030 Addison Street, Suite 410, Berkeley, CA 94704-2642 USA ,grid.47840.3f0000 0001 2181 7878School of Public Health, University of California, Berkeley, USA
| | - Bonnie O. Richard
- grid.280247.b0000 0000 9994 4271Pacific Institute for Research and Evaluation, 401 West Main Street, Suite 2100, Louisville, KY 40202 USA
| | - Camila Aramburu
- grid.47840.3f0000 0001 2181 7878Prevention Research Center, Pacific Institute for Research and Evaluation, 2030 Addison Street, Suite 410, Berkeley, CA 94704-2642 USA
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Roberts ME, Keller-Hamilton B, Ferketich AK. Testing if attitudes mediate the association between advertising exposure and adolescent tobacco use. Addict Behav 2022; 134:107415. [PMID: 35763986 DOI: 10.1016/j.addbeh.2022.107415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/30/2022] [Accepted: 06/20/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION A growing body of evidence indicates that exposure to tobacco advertising among adolescents increases the likelihood of subsequent tobacco use. It is important to understand the process by which this occurs, in order to appropriately target factors for intervention. The objective of this study was to test whether attitudes towards tobacco advertising mediates the impact of advertising exposure on tobacco use. METHODS From an ongoing prospective cohort study of male adolescents (aged 11-16 at baseline), we recruited a subset of tobacco users and non-users to participate in an additional ecological momentary assessment (EMA) project (N = 164). Adolescents completed smartphone-based surveys 2-3 times/day over a 10-day period with items assessing their exposures and attitudes towards tobacco-related advertising. If participants reported exposure to tobacco advertising, they were asked about their attitudes toward it (how much they enjoyed it, liked it, and found it appealing). RESULTS Adolescents who reported a greater amount of advertising exposure during the EMA period were more likely to report past-30-day tobacco use at their next cohort follow-up (6-12 months later). Moreover, the impact of advertising exposure on subsequent use was mediated by attitudes toward the tobacco advertisements, as reported during the EMA. This effect remained after controlling for baseline tobacco use. CONCLUSIONS By pairing EMA with long-term follow-up, we identified attitudes as a mediator between adolescent advertising exposure and subsequent tobacco use. Interventions to lessen adolescents' positive attitudes toward tobacco advertisements may help disrupt this impact.
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Affiliation(s)
- Megan E Roberts
- College of Public Health, The Ohio State University, Columbus, OH, USA.
| | - Brittney Keller-Hamilton
- Center for Tobacco Research, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Amy K Ferketich
- College of Public Health, The Ohio State University, Columbus, OH, USA
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Chen-Sankey JC, van de Venne J, Westneat S, Rahman B, Folger S, Anesetti-Rothermel A, Debnam C, Ribisl KM, Cohn A, Rose SW. Real-Time Context of Tobacco Marketing Exposure and Community Vulnerability-An Ecological Momentary Assessment Among Young Adults. Ann Behav Med 2022; 56:620-631. [PMID: 34323267 PMCID: PMC9242544 DOI: 10.1093/abm/kaab066] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Exposure to tobacco product marketing increases tobacco use among young adults, especially those from vulnerable communities (VCs). PURPOSE This study examined real-time tobacco marketing exposure among young adults from vulnerable and non-vulnerable communities using Ecological Momentary Assessment (EMA). METHODS This study used EMA data to assess context (e.g., location and activity) of tobacco marketing exposure using four text-messaging surveys per day over 2 weeks. Young adult non-current tobacco users living in Washington, D.C. (n = 146; ages 18-24) recorded 5,285 surveys, including 20 participants (13.2%) from VCs with high proportions of lower income and racial/ethnic minorities, and high smoking rates. Unadjusted and adjusted multilevel logistic regressions were used to assess the associations between exposure to any and flavored tobacco marketing, VC residence, and real-time context. RESULTS Fifty-nine participants (40.4%) reported at least one tobacco marketing exposure and recorded 94 exposure moments. In adjusted models, odds of exposure were higher among VC residents (AOR = 2.6, 95% CI = 1.2-5.4), in the presence of anyone using tobacco versus no use (AOR = 4.0, 95% CI = 2.4-6.7), at store/retail (AOR = 17.0, 95% CI = 6.4-44.8), or outside/in transit (AOR = 4.1, 95% CI = 2.1-7.8) versus at home. VC residence (AOR = 7.2, 95% CI = 2.3-22.2) was the strongest predictor of flavored tobacco marketing exposure among all covariates examined. CONCLUSIONS Young adults are predominantly exposed to tobacco marketing in their daily lives through retail advertisements. Young adults from VCs are at increased risks of seeing any tobacco and especially flavored tobacco marketing. Policies that curtail tobacco retailer density and advertisement displays may reduce overall and differential tobacco marketing exposure.
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Affiliation(s)
- Julia C Chen-Sankey
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Judy van de Venne
- Center for Health Equity Transformation, Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Susan Westneat
- Center for Health Equity Transformation, Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Basmah Rahman
- Truth Initiative Schroeder Institute®, Washington, DC, USA
| | - Shanell Folger
- Truth Initiative Schroeder Institute®, Washington, DC, USA
| | - Andrew Anesetti-Rothermel
- Center for Health Equity Transformation, Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amy Cohn
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shyanika W Rose
- Center for Health Equity Transformation, Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
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Nixon DE, Ferketich AK, Slater MD, Mays D, Keller-Hamilton B. Prospective associations between attitudes toward alcohol advertisements and alcohol use behaviors among adolescent boys. Addict Behav Rep 2022; 15:100428. [PMID: 35495417 PMCID: PMC9051624 DOI: 10.1016/j.abrep.2022.100428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/23/2022] [Accepted: 04/16/2022] [Indexed: 11/10/2022] Open
Abstract
Exposure to alcohol advertisements is associated with drinking among adolescents. Little is known about attitudes toward advertisements and drinking. Positive attitudes toward advertisements affect alcohol use prospectively. Media literacy programs should address attitudes toward alcohol advertisements.
Objectives Earlier initiation of alcohol use and problematic drinking among adolescents are linked with adverse health outcomes. Exposure to alcohol advertisements is associated with drinking among adolescents, but the association between the attitudes toward alcohol advertisements and drinking behaviors is understudied. We evaluated the association between attitudes towards alcohol advertisements and initiation of alcohol use among adolescent boys. Methods Adolescent boys from urban and Appalachian Ohio enrolled in a prospective study and reported whether they had ever consumed alcohol or been drunk at baseline (N = 1220; ages 11–16 years) and at the 24-month follow up (N = 891). Attitudes toward alcohol advertisements were measured at baseline following a brief advertisement viewing activity. Adjusted logistic regression models were used to estimate associations between attitudes toward advertisements and initiating alcohol use or drunkenness at the 24-month follow-up. Results Adolescent boys reporting any positive attitudes toward alcohol advertisements had higher odds of initiating alcohol use (aOR = 2.00, 95% CI [1.16, 3.44]), and attitudes were marginally associated with incident drunkenness (aOR = 2.20, 95% CI [0.94, 5.12]). Increasing age, higher household income, ever use of tobacco, and frequency of visiting alcohol retailers were also associated with greater odds of incident alcohol use and/or drunkenness. Conclusions Attitudes toward alcohol advertisements at baseline were associated with alcohol drinking behaviors 24-months later among adolescent boys. Results highlight the importance of media literacy interventions targeted to adolescents.
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Stritzel H. Peer and Community Influences on Adolescent Substance Use in the Context of Adverse Childhood Experiences. SOCIOLOGICAL PERSPECTIVES : SP : OFFICIAL PUBLICATION OF THE PACIFIC SOCIOLOGICAL ASSOCIATION 2022; 65:413-432. [PMID: 36186534 PMCID: PMC9524267 DOI: 10.1177/07311214211018718] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Both adverse childhood experiences (ACEs) and peer influences consistently predict early tobacco, alcohol, and illicit drug use. However, less research considers how peer and community influences contribute to or modify the association between ACEs and early substance use. This study addresses these gaps in the literature by analyzing multilevel, longitudinal data from the Project on Human Development in Chicago Neighborhoods (PHDCN; N = 1,912). Unstructured socializing and peer substance use largely explained the association between ACEs and drinking, smoking cigarettes, and illicit drug use in the past month. A history of ACEs magnified the association between peer substance use and the number of cigarettes smoked. Collective efficacy also shaped the associations between peer influences, ACEs, and substance use, but in different ways depending on the substance use outcome analyzed.
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Blake KD, Gaysynsky A, Mayne RG, Seidenberg AB, Kaufman A, D'Angelo H, Roditis M, Vollinger RE. U.S. public opinion toward policy restrictions to limit tobacco product placement and advertising at point-of-sale and on social media. Prev Med 2022; 155:106930. [PMID: 34954242 PMCID: PMC8896313 DOI: 10.1016/j.ypmed.2021.106930] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 02/03/2023]
Abstract
The Family Smoking Prevention and Tobacco Control Act granted the U.S. Food and Drug Administration authority to regulate tobacco advertising and promotion, including at the retail level, and preserved state, tribal, and local tobacco advertising and promotion authorities. Public health experts have proposed prohibiting point-of-sale tobacco advertisements and product displays, among other tobacco advertising restrictions. We examined the prevalence and correlates of public support, opposition, and neutrality toward proposed tobacco product placement and advertising restrictions at point-of-sale and on social media utilizing the National Cancer Institute's 2020 Health Information National Trends Survey (HINTS) (N = 3865), a cross-sectional, probability-based postal survey of U.S. addresses conducted from Feb 24, 2020 to June 15, 2020 (Bethesda, MD). Frequencies and unadjusted, weighted proportions were calculated for support, neutrality, and opposition toward the three policies under study, and weighted, adjusted multivariable logistic regression was employed to examine predictors of neutrality and opposition. Tests of significance were conducted at the p < 0.05 level. Sixty-two percent of U.S. adults supported a policy prohibiting tobacco product advertising on social media; 55% supported a policy restricting the location of tobacco product advertising at point-of-sale; and nearly 50% supported a policy to keep tobacco products out of view at the checkout counter. Neutrality and opposition varied by sociodemographic characteristics including age, sex, education, rurality, and presence of children in the household. Understanding public opinion toward tobacco product placement and advertising restrictions may inform policy planning and implementation.
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Affiliation(s)
- Kelly D Blake
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
| | - Anna Gaysynsky
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA; ICF Next, Rockville, MD, USA
| | - Rachel Grana Mayne
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Andrew B Seidenberg
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Annette Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Heather D'Angelo
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Maria Roditis
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Robert E Vollinger
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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Ferschke N. Preventing and Treating Tobacco Use. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ozga JE, Romm KF, Turiano NA, Douglas A, Dino G, Alexander L, Blank MD. Cumulative disadvantage as a framework for understanding rural tobacco use disparities. Exp Clin Psychopharmacol 2021; 29:429-439. [PMID: 34014742 PMCID: PMC9752977 DOI: 10.1037/pha0000476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Traditional tobacco product (cigarettes and smokeless tobacco) and polytobacco use rates are significantly higher among rural adolescents and adults compared to their nonrural counterparts. Such disparities are due to several factors that promote tobacco use initiation and continuation, including individual-level psychopharmacological factors and structural-level factors such as fewer tobacco control efforts (e.g., fewer smoke-free policies and lower tobacco excise taxes), targeted tobacco marketing, less access to health-relevant resources, and more positive cultural norms surrounding tobacco use in rural communities. In this review, we use cumulative disadvantage theory as a framework for understanding how psychopharmacological and structural-level factors serve as drivers of tobacco use in rural areas. We start by describing how structural-level differences between rural-nonrural communities impact psychopharmacological influences and, when available, how these factors influence tobacco use. We conclude by discussing the interplay between factors, providing suggestions for ways to assess our application of cumulative disadvantage theory empirically and making recommendations for research and policy implementation in rural areas. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Jenny E. Ozga
- Department of Behavioral Medicine and Psychiatry, West Virginia University
| | - Katelyn F. Romm
- Milken Institute School of Public Health, George Washington University
| | - Nicholas A. Turiano
- Department of Psychology, West Virginia University
- West Virginia Prevention Research Center, West Virginia University
| | | | - Geri Dino
- Department of Social and Behavioral Sciences, Clinical and Translational Sciences Institute, West Virginia University
- West Virginia Prevention Research Center, West Virginia University
| | - Linda Alexander
- Department of Social and Behavioral Sciences, Clinical and Translational Sciences Institute, West Virginia University
| | - Melissa D. Blank
- Department of Psychology, West Virginia University
- West Virginia Prevention Research Center, West Virginia University
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Abstract
This chapter reviews the array of methods used in contemporary research on population-level research on substance use and its consequences. We argue that there are critical questions that can best - or in some cases, only - be addressed at the level of a population. We then describe the major categories of data collection methods used in population research, including surveys, ecological momentary assessment, administrative data, audit methods, and unobtrusive assessment of substance use. Two categories of measures are then discussed: measures of an individual's use of substances and related problems and measures of harm to others caused by one's use. We then review factors that may be considered causes or correlates of substance use and consequences, including both individual and environmental factors. We close with a few thoughts on the accumulation of knowledge and its translation to policy and practice.
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