Nearly 7 in 10 middle and high school students are exposed to e-cigarette ads, and that might help explain why the electronic devices are now the most popular tobacco product among these children, U.S. health officials said Tuesday.
Results from the National Youth Tobacco Survey reveal that 66% of middle school students and 71% of high school students saw at least one e-cigarette advertisement in 2014. That suggests that 18.3 million students across the country viewed promotional materials in stores, online, in newspapers or magazines, or on TV or at the movies, according to a new report from the Centers for Disease Control and Prevention.
Money spent on e-cigarette ads rose from $6.4 million in 2011 to $115 million in 2014, researchers estimate. Over that period, the proportion of middle school students who said they used e-cigarettes in the previous 30 days increased from 0.6% to 3.9%. For high school students, recent e-cigarette use jumped from 1.5% to 13.4% between 2011 and 2014.
Dr. Tom Frieden, director of the CDC, said the fact that ad spending and e-cigarette use rose in tandem is probably not a coincidence.
The authors of the new study, published in the CDC's Morbidity and Mortality Weekly Report, were more circumspect about making a connection. The fact that so many children have seen ads for e-cigarettes "might be contributing to increasing youth experimentation with and use of e-cigarettes in recent years," they wrote.
The survey results are based on responses from 22,007 children in grades 6 through 12 who attend public or private schools. Overall, 55% of survey respondents saw e-cigarettes advertised in retail stores, 40% saw ads for them on the Internet, 37% encountered them while watching movies or television, and 30% noticed them in magazines and newspapers.
Most of these children saw multiple ads in multiple places. Only 22% of the students surveyed saw ads in just one of these four venues, according to the report. However, 17% said they saw them in two places, 14% saw them in three places, and 15% saw them in all four places.
The true extent of advertising exposure might be wider, since students who took the survey weren't asked about exposure to e-cigarette ads on billboards, at sporting events or in other places, the study authors wrote.
Although the study didn't make a direct link between ad exposure and vaping, the authors said the pervasiveness of e-cigarette marketing messages threatened to undermine progress in getting children to shun tobacco products. A 2015 study in the American Journal of Preventive Medicine found that teens who saw ads for e-cigarettes on TV were 43% more likely to say they would try the devices in the next year than were teens who didn't see the ads, they noted.
E-cigarettes users inhale a vapor that typically includes nicotine derived from tobacco, and some studies suggest that kids who try e-cigarettes are more likely to smoke to traditional cigarettes.
"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," the study authors concluded.
Key public health groups echoed their call.
"It is unacceptable that e-cigarette advertising remains unrestricted," American Heart Assn. Chief Executive Nancy Brown said in a statement. "Kids are encountering these ads virtually everywhere – in stores, online, in newspapers and magazines, and on television and in movies. And the sad truth is, it's working."
Harold Wimmer, national president and chief executive of the American Lung Assn., said it was "unacceptable and dangerous" to have so many kids exposed to so many e-cigarette ads.
"The U.S. Surgeon General has found that tobacco and nicotine are not safe, and nicotine negatively impacts adolescent brain development and has been associated with lasting cognitive and behavioral impairments, including effects on working memory and attention in youth," he said in a statement.
"Once the FDA has authority, the American Lung Association urges it to act swiftly to crack down and end marketing practices aimed at youth," Wimmer added. "It is also incumbent on states to enact and enforce laws to stop retailers from selling these products to children."
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