Effect of e-cigarette advertisement themes on hypothetical e-cigarette purchasing in price-responsive adolescents.

ABSTRACT

AIMS: To examine the effect on adolescents of exposure to different e-cigarette advertisement themes on reported likelihood of purchasing e-cigarettes in a hypothetical scenario. DESIGN: Between-subjects design of four randomly assigned thematic conditions derived from a content analysis of 350 e-cigarette advertisements general, flavor- and taste-themed, people- and product use-themed or control advertisements for bottled water. SETTING: Virginia, USA. PARTICIPANTS: Of 1360 adolescents (13-18 years old) participating, 1063 had complete data (519 current cigarette smokers, 544 tobacco-susceptible non-smokers). MEASUREMENTS Participants completed an e-cigarette purchase task, reporting the likelihood of buying an e-cigarette at various prices. Indices of abuse liability included price responsiveness (whether likelihood of purchase decreased with increasing prices) and, among price-responsive adolescents, breakpoint (highest price before definitely would not buy), maximum probability-weighted expenditure (Omax ) and price elasticity (how quickly willingness to purchase decreases as prices increase). Regressions controlled for demographics, prior tobacco ad exposure, tobacco/substance use and sensation-seeking. FINDINGS: Prior advertisement exposure was positively associated with being price-responsive [odds ratio (OR) = 1.12, 95% confidence interval (CI) = 1.03, 1.22; P < 0.05]. Among price-responsive adolescents (n = 579), breakpoints were 58% higher in the flavor- and taste-themed condition (ß = 0.46, 95% CI = <0.01, 0.92) and 75% higher in the people- and product use-themed condition (ß = 0.56, 95% CI = 0.10, 1.03) compared with control (Ps < 0.05). Exposure to people- and product use-themed advertisements was associated with a 60% higher Omax (ß = 0.47, 95% CI = 0.01, 0.93; P < 0.05). The general and people- and product use-themed conditions were associated with 19% (ß = -0.21, 95% CI = -0.38, -0.04) and 21% (ß = -0.24, 95% CI = -0.42, -0.06) lower elasticity, respectively (Ps < 0.05). CONCLUSIONS: E-cigarette advertising exposure may increase reported likelihood of purchasing e-cigarettes, with effects differing by advertisement content. People- and product use-themed e-cigarette advertisements increased reported likelihood of purchasing in price-responsive adolescents.