Send to

Choose Destination
ERJ Open Res. 2018 Nov 28;4(4). pii: 00155-2018. doi: 10.1183/23120541.00155-2018. eCollection 2018 Oct.

Electronic cigarette marketing and smoking behaviour in adolescence: a cross-sectional study.

Author information

Institute for Therapy and Health Research, Kiel, Germany.


The aim of this study was to investigate the association between exposure to electronic cigarette (e-cigarette) advertisements and use of e-cigarettes, combustible cigarettes and hookahs. A cross-sectional survey of 6902 German students (mean age 13.1 years, 51.3% male) recruited in six German states was performed. Exposure to e-cigarette advertisements was measured with self-rated contact frequency to three advertising images. Multilevel mixed-effect logistic regression models were used to assess associations between exposure to e-cigarette advertisement and use of e-cigarettes, combustible cigarettes and hookahs (ever and past 30 days). Overall, 38.8% of the students were exposed to e-cigarette advertisements; ever-use of e-cigarettes was 21.7%, of combustible cigarettes was 21.8% and of hookahs was 23.2%, and poly-use of all three products was 12.4%. Exposure to e-cigarette advertisements was positively related to ever and past 30-day use of e-cigarettes, combustible cigarettes, hookahs and combined use. We concluded that a considerable number of German teenagers are exposed to e-cigarette advertisement. There was a clear exposure-behaviour link, indicating that advertising contact was associated with different kinds of "vaping" and also smoking behaviour. Although causal interpretation is not possible due to the cross-sectional design, findings raise concerns about the current tobacco control policies.

Conflict of interest statement

Conflict of interest: J. Hansen has nothing to disclose. Conflict of interest: R. Hanewinkel has nothing to disclose. Conflict of interest: M. Morgenstern has nothing to disclose.

Supplemental Content

Full text links

Icon for PubMed Central
Loading ...
Support Center