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BMJ Open. 2018 Jul 16;8(7):e020247. doi: 10.1136/bmjopen-2017-020247.

E-cigarette adverts and children's perceptions of tobacco smoking harms: an experimental study and meta-analysis.

Author information

1
Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
2
Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge, UK.

Abstract

OBJECTIVES:

Children exposed to electronic cigarette (e-cigarette) adverts may perceive occasional tobacco smoking as less harmful than children not exposed to e-cigarette adverts. Given the potential cross-cueing effects of e-cigarette adverts on tobacco smoking, there is an urgent need to establish whether the effect found in prior research is robust and replicable using a larger sample and a stronger control condition.

DESIGN:

A between-subjects experiment with one independent factor of two levels corresponding to the advertisements to which participants were exposed: glamorous adverts for e-cigarettes, or adverts for objects unrelated to smoking or vaping.

PARTICIPANTS:

English school children aged 11-16 (n=1449).

OUTCOMES:

Perceived harm of occasional smoking of one or two tobacco cigarettes was the primary outcome. Secondary outcomes included: perceived harm of regular tobacco smoking, susceptibility to tobacco smoking and perceived prevalence of tobacco smoking in young people. Perceptions of using e-cigarettes were gauged by adapting all the outcome measures used to assess perceptions of tobacco smoking.

RESULTS:

Tobacco smokers and e-cigarette users were excluded from analyses (final sample n=1057). Children exposed to glamorous e-cigarette adverts perceived the harms of occasional smoking of one or two tobacco cigarettes to be lower than those in the control group (Z=-2.13, p=0.033). An updated meta-analysis comprising three studies with 1935 children confirmed that exposure to different types of e-cigarette adverts (glamorous, healthful, flavoured, non-flavoured) lowers the perceived harm of occasional smoking of one or two tobacco cigarettes (Z=3.21, p=0.001).

CONCLUSIONS:

This study adds to existing evidence that exposure to e-cigarette adverts reduces children's perceptions of the harm of occasional tobacco smoking.

KEYWORDS:

e-cigarette marketing; electronic cigarettes; preventive medicine; priority populations; public health; tobacco smoking

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