Adolescent Attentional Bias toward Real-world Flavored E-cigarette Marketing

A comprehensive content analysis of 104 Chinese electronic cigarette manufacturing enterprise official websites

OBJECTIVE

The goal was to analyse website content of Chinese electronic (e) cigarette manufacturing enterprises and understand the marketing strategies to provide evidence for decision-makers to regulate manufacturers.

METHODS

Through QCC.com, one of the largest enterprise information query platforms in China, we identified 104 official manufacturer websites in 2021. A codebook including 6 sections with 31 items was developed and all webpages were coded separately by two trained researchers.

RESULTS

Over half of the websites (56.7%) did not have age verification for entry. Thirty-two (30.8%) websites had no restriction for minors to use or purchase e-cigarettes, and 79 (76.0%) had no health warning. Overall, 99 websites (95.2%) displayed their products, and 72 (69.2%) displayed e-flavours. The most frequently used descriptions of products included good taste (68.3%), positive mood (62.5%), leakage resistance (56.7%), enjoyment (47.1%), reduced harm (45.2%), alternatives to cigarettes (43.3%) and long battery life (42.3%). Additionally, 75 websites (72.1%) provided contact information on different channels, including WeChat (59.6%), Weibo (41.3%), Facebook (13.5%), Instagram (12.5%) and brand apps (2.9%). Manufacturers provided investment and franchise information (59.6%) and offline store information (17.3%). In addition, 41.3% websites included content regarding corporate social responsibility.

CONCLUSIONS

Chinese e-cigarette manufacturers' official websites have become a platform for presenting product and brand information, establishing online and offline marketing loops, and displaying corporate social responsibility with weak age restrictions on access and a lack of health warnings. The Chinese government should implement strict regulatory measures on e-cigarette enterprises.

Testing if attitudes mediate the association between advertising exposure and adolescent tobacco use

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.

Associations between perceived source credibility, e-cigarettes, and e-cigarette ad perceptions

The use of e-cigarettes among U.S. adults remains high, and aggressive industry advertising is a contributor. Consumer opinions of the e-cigarette industry's credibility can influence e-cigarette product and ad perceptions. The purpose of this study was to examine the association of perceived source credibility of e-cigarette ads and consumer attitudes toward e-cigarette ads and product use. In October 2021, we conducted a survey using an online convenience sample (N = 497, Mage = 31.9). Participants viewed two randomly selected e-cigarette ads and were asked questions regarding source credibility, perceptions of the ads, and e-cigarette use. Linear mixed effects models with random intercepts were used to estimate associations between perceived source credibility with perceived ad relevance, effectiveness, liking, product use interest, and e-cigarette harms perceptions. We also tested whether associations between perceived source credibility and ad and e-cigarette perceptions were moderated by e-cigarette use. Models controlled for cigarette smoking status, age, sex, race, ethnicity, sexual orientation, and income. Perceived source credibility was positively associated with increased perceived ad relevance, effectiveness, liking, and product use interest (ps < 0.001). E-cigarette use moderated associations of perceived source credibility and perceived ad relevance, perceived ad effectiveness, and interest in using e-cigarettes, with associations being strongest among never users. Findings suggest that tobacco control messaging aiming to reduce the credibility of the e-cigarette industry might be most effective among adults who have never used e-cigarettes.

Eye tracking applied to tobacco smoking: current directions and future perspectives

Over the years the general awareness of the health costs associated with tobacco smoking has motivated scientists to apply the measurement of eye movements to this form of addiction. On one hand they have investigated whether smokers attend and look preferentially at smoking related scenes and objects. In parallel, on the other hand eye tracking has been used to test how smokers and nonsmokers interact with the different types of health warning that policymakers have mandated in tobacco advertisements and packages. Here we provide an overview of the main findings from the different lines of research, such as the evidence related to the attentional bias for smoking cues in smokers and the evidence that graphic warning labels and plain packages measurably increase the salience of the warning labels. We point to some open questions, such as the conditions that determine whether heavy smokers exhibit a tendency to actively avoid looking at graphic warning labels. Finally we argue that the research applied to gaze exploration of warning labels would benefit from a more widespread use of the more naturalistic testing conditions (e.g. mobile eye tracking or virtual reality) that have been introduced to study the smokers' attentional bias for tobacco-related objects when freely exploring the surrounding environment.