Abstract
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.
Abstract
E-cigarette advertising reaches a considerable number of German teenagers. Exposure is positively related to use of e-cigarettes, combustible cigarettes and hookahs, and combined use. Findings raise concerns about the current tobacco control policies. http://ow.ly/mbWm30mspIT
Footnotes
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.
Support statement: The study was supported by DAK-Gesundheit, a German health insurance company. DAK-Gesundheit had no role in the design of the study or during its execution, analyses or interpretation of the data, or in the decision to submit results. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received September 8, 2018.
- Accepted October 28, 2018.
- Copyright ©ERS 2018
This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.