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

Julia Hansen, Reiner Hanewinkel, Matthis Morgenstern
ERJ Open Research 2018 4: 00155-2018; DOI: 10.1183/23120541.00155-2018
Julia Hansen
Institute for Therapy and Health Research, Kiel, Germany
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  • For correspondence: hansen@ift-nord.de
Reiner Hanewinkel
Institute for Therapy and Health Research, Kiel, Germany
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Matthis Morgenstern
Institute for Therapy and Health Research, Kiel, Germany
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Tables

  • TABLE 1

    Descriptive sample statistics and use of electronic cigarettes, combustible cigarettes and hookahs

    CharacteristicsTotal sampleExposed to e-cigarette advertisementsCrude OR of e-cigarette advertisement exposure
    No (0=ref)Yes (1)
    Respondents6902 (100)4193 (61.2)2529 (38.8)
    Mean±sd age years13.1±1.8512.9±1.8613.3±1.801.1 (1.1–1.2)***
    Sex
     Female (0)3356 (48.7)2159 (50.2)1194 (46.2)1.2 (1.1–1.3)***
     Male (1)3533 (51.3)2138 (49.8)1388 (53.8)
    School type
     High academic level (0)3541 (51.3)2313 (53.7)1221 (47.2)1.3 (1.2–1.4)***
     Lower academic level (1)3361 (48.7)1992 (46.3)1366 (52.8)
    Migration background
     No (0)5605 (81.3)3547 (82.5)2054 (79.6)1.2 (1.1–1.4)**
     Yes (1)1288 (18.7)745 (17.5)528 (20.5)
    Socioeconomic status#
     Low (0)1307 (19.3)823 (19.5)484 (19.0)1.0 (1.0–1.1)
     Medium (1)3568 (52.6)2225 (52.6)1338 (52.6)
     High (2)1908 (28.1)1183 (28.0)721 (28.4)
    Sensation seeking¶
     Low (0)4046 (58.9)2739 (63.9)1304 (50.6)1.7 (1.6–1.9)***
     High (1)2828 (41.1)1551 (36.2)1272 (49.4)
    Consumer susceptibility to interpersonal influence¶
     Low (0)3442 (50.5)2295 (54.0)1143 (44.6)1.5 (1.3–1.6)***
     High (1)3377 (49.5)1956 (46.0)1420 (55.4)
    Substance use+
     Ever e-cigarette use
      Yes (1)1307 (21.7)597 (15.9)709 (31.0)2.4 (2.1–2.7)***
      No (0)5536 (78.3)3679 (84.1)1851 (69.0)
     Current e-cigarette use
      Yes (1)223 (3.9)69 (1.9)154 (7.1)4.0 (2.9–5.5)***
      No (0)6628 (96.1)4210 (98.1)2411 (92.9)
     Ever cigarette smoking
      Yes (1)1351 (21.8)655 (17.1)694 (29.3)2.0 (1.7–2.3)***
      No (0)5499 (78.2)3623 (82.9)1870 (70.7)
     Current cigarette smoking
      Yes (1)375 (6.0)162 (4.2)213 (8.8)2.2 (1.8–2.8)***
      No (0)6475 (94.0)4116 (95.8)2351 (91.2)
     Ever hookah smoking
      Yes (1)1388 (23.2)644 (17.3)743 (32.6)2.3 (2.0–2.6)***
      No (0)5450 (76.8)3629 (82.7)1814 (67.4)
     Current hookah smoking
      Yes (1)344 (6.1)141 (4.2)202 (9.2)2.3 (1.8–3.0)***
      No (0)6499 (93.9)4135 (95.8)2357 (90.8)
     Ever dual-use e-cigarette/cigarette
      Yes (1)874 (14.6)381 (10.3)493 (21.4)2.4 (2.0–2.8)***
      No (0)5924 (85.4)3870 (89.7)2074 (78.6)
     Current dual-use e-cigarette/cigarette
      Yes (1)94 (1.5)26 (0.6)68 (3.0)4.9 (3.0–8.0)***
      No (0)6710 (98.5)4227 (99.4)2476 (97.0)
     Ever dual-use e-cigarette/hookah
      Yes (1)988 (16.9)427 (11.7)560 (25.3)2.6 (2.2–3.0)***
      No (0)5799 (83.1)3820 (88.3)1973 (74.7)
     Current dual-use e-cigarette/hookah
      Yes (1)138 (2.5)42 (1.2)96 (4.6)3.9 (2.6–5.8)***
      No (0)6660 (97.5)4210 (98.8)2443 (95.4)
     Ever dual-use cigarette/hookah
      Yes (1)890 (14.9)395 (10.9)495 (21.4)2.2 (1.9–2.6)***
      No (0)5933 (85.1)3868 (89.1)2057 (78.6)
     Current dual-use cigarette/hookah
      Yes (1)115 (2.0)38 (1.1)77 (3.3)3.2 (2.0–5.1)***
      No (0)6714 (98.0)4229 (98.9)2477 (96.7)
     Ever poly-use e-cigarettes/cigarette/hookah
      Yes (1)725 (12.4)304 (8.5)421 (18.6)2.5 (2.1–2.9)***
      No (0)6049 (87.6)3934 (91.5)2108 (81.4)
     Current poly-use e-cigarettes/cigarette/hookah
      Yes (1)62 (1.0)15 (0.4)47 (2.1)5.3 (2.8–10.0)***
      No (0)6722 (99.0)4288 (99.6)2487 (97.9)

    Data are presented as n (%) or OR (95% CI), unless otherwise stated. Differences in sample size (total sample versus exposure to e-cigarette advertisements) are based on missing data. ref: reference. #: tertile split; ¶: median split; +: substance use data were weighted to census data (age, sex, migration background, school type) to consider disproportion of selected sample; census data were obtained from the German Federal Office of Statistics. **: p≤0.01; ***: p≤0.001.

    • TABLE 2

      Relationships between exposure to e-cigarette advertisements and ever-use of electronic cigarettes, combustible cigarettes and hookahs

      Outcomes (dichotomous) ever-use#E-cigarette use¶Cigarette use+Hookah use§E-cigarette/cigarette use+E-cigarette/hookah use§Cigarette/hookah useƒE-cigarette/cigarette/hookah useƒ
      Exposure to e-cigarette advertisements1.6 (1.3–1.8)***1.2 (1.0–1.4)*1.4 (1.2–1.7)***1.6 (1.3–1.9)***1.7 (1.4–2.0)***1.4 (1.1–1.7)*1.7 (1.4–2.1)***
      Age1.5 (1.4–1.5)***1.4 (1.3–1.5)***1.2 (1.2–1.4)***1.5 (1.4–1.6)***1.5 (1.4–1.6)***1.4 (1.3–1.5)***1.5 (1.4–1.6)***
      Sex (ref=female)1.5 (1.3–1.8)***0.8 (0.7–1.0)*1.3 (1.1–1.6)*1.1 (0.9–1.3)1.4 (1.2–1.7)***0.9 (0.7–1.1)1.1 (0.9–1.4)
      School type (ref=high)1.8 (1.4–2.4)***1.8 (1.3–2.5)***1.8 (1.4–2.2)***2.0 (1.5–2.9)***2.1 (1.6–2.8)***1.6 (1.1–2.2)*2.1 (1.4–2.9)***
      Migration background (ref=none)1.2 (0.9–1.4)0.7 (0.5–0.9)*2.2 (1.8–2.8)***0.8 (0.6–1.1)1.3 (1.0–1.7)*1.1 (0.8–1.4)1.0 (0.8–1.3)
      Socioeconomic status (ref=low)1.0 (1.0–1.1)1.0 (0.9–1.0)1.0 (1.0–1.1)1.0 (0.9–1.1)1.1 (1.0–1.2)*1.0 (0.9–1.1)1.0 (1.0–1.1)
      Sensation seeking (ref=low)1.7 (1.6–1.8)***1.7 (1.6–1.9)***1.5 (1.3–1.6)***1.8 (1.7–2.0)***1.7 (1.6–1.9)***1.6 (1.4–1.8)***1.8 (1.7–2.1)***
      Consumer susceptibility (ref=low)1.1 (1.0–1.2)1.0 (0.9–1.1)1.1 (1.0–1.3)*1.1 (0.9–1.2)1.1 (1.0–1.3)*1.1 (0.9–1.3)1.1 (0.9–1.2)
      E-cigarette use##7.6 (6.2–9.3)***14.9 (12.1–18.5)***12.6 (9.9–16.0)***
      At least one friend vaping e-cigarettes3.9 (3.1–4.8)***0.9 (0.7–1.2)0.9 (0.7–1.2)3.5 (2.7–4.7)***3.6 (2.8–4.7)***0.9 (0.7–1.2)3.1 (2.3–4.3)***
      At least one friend smoking cigarettes1.8 (1.5–2.3)***4.6 (3.6–5.8)***1.4 (1.1–1.7)***4.1 (3.0–5.7)***2.2 (1.7–2.8)***4.6 (3.2–6.5)***4.1 (2.8–5.9)***
      At least one friend smoking hookahs2.3 (1.8–2.9)***1.7 (1.3–2.1)***6.2 (4.7–8.2)***2.2 (1.5–3.0)***4.4 (3.1–6.2)***5.2 (3.4–7.8)***5.1 (3.3–8.1)***

      Data are presented as adjusted odds ratio (95% CI). ref: reference. #: models adjusted for age, sex, migration background, school type, consumer susceptibility to interpersonal influence, socioeconomic status, sensation seeking, and e-cigarette use of at least one friend; ¶: n=6573; +: n=6532; §: n=6523; ƒ: n=6511; ##: e-cigarette use was omitted where e-cigarette use was modelled as an outcome. *: p<0.05; ***: p≤0.001; all models allow for nested data (p<0.001).

      • TABLE 3

        Relationships between exposure to e-cigarette advertisements and past 30-day use of electronic cigarettes, combustible cigarettes and hookahs

        Outcomes (dichotomous) current use#E-cigarette use¶Cigarette use+Hookah use§E-cigarette/cigarette useƒE-cigarette/hookah use##Cigarette/hookah use¶¶E-cigarette/cigarette/hookah use++
        Exposure to e-cigarette advertisements2.3 (1.6–3.2)***1.4 (1.1–1.9)*1.3 (1.0–1.7)*2.4 (1.5–4.1)***2.2 (1.5–3.4)***1.8 (1.1–2.9)*3.4 (1.8–6.5)***
        Age1.3 (1.1–1.5)***1.6 (1.4–1.8)***1.4 (1.3–1.5)***1.5 (1.2–1.8)***1.3 (1.1–1.5)*1.6 (1.3–1.9)***1.8 (1.5–2.2)***
        Sex (ref=female)1.2 (0.9–1.7)0.5 (0.4–0.6)***1.0 (0.7–1.3)0.5 (0.3–0.9)*1.0 (0.7–1.5)0.5 (0.3–0.9)*0.4 (0.2–0.8)*
        School type (ref=high)2.1 (1.3–3.3)*1.5 (0.9–2.5)1.7 (1.1–2.6)*2.2 (1.2–3.9)*3.1 (1.7–5.5)***1.4 (0.8–2.4)2.8 (1.3–6.1)*
        Migration background (ref=none)0.9 (0.6–1.4)0.4 (0.3–0.7)***2.2 (1.6–3.0)***0.4 (0.2–0.9)*1.3 (0.8–2.0)0.8 (0.4–1.3)0.5 (0.2–1.2)
        Socioeconomic status (ref=low)1.1 (1.0–1.3)0.9 (0.8–1.0)1.1 (1.0–1.2)*1.0 (0.9–1.2)1.0 (1.0–1.3)1.0 (0.9–1.2)1.1 (0.9–1.3)
        Sensation seeking (ref=low)2.2 (1.9–2.6)***1.8 (1.5–2.1)***1.7 (1.5–1.9)***2.8 (2.2–3.7)***2.4 (2.0–2.9)***2.3 (1.8–3.0)***3.9 (2.8–5.5)***
        Consumer susceptibility (ref=low)1.1 (0.9–1.4)1.1 (0.9–1.3)1.3 (1.1–1.5)*1.2 (0.9–1.6)1.2 (0.9–1.5)1.6 (1.2–2.1)***1.3 (0.9–1.9)
        E-cigarette use7.7 (5.4–11.1)***8.4 (5.8–12.3)***11.5 (5.3–25.3)***
        At least one friend vaping e-cigarettes§§18.1 (6.2–52.6)***1.0 (0.7–1.6)1.8 (1.1–3.0)*30.3 (3.8–240.5)***30.5 (4.0–231.1)***3.9 (1.5–10.3)*
        At least one friend smoking cigarettes§§2.3 (1.3–4.3)*38.9 (9.3–163.1)***1.4 (0.9–2.2)1.7 (0.8–3.6)
        At least one friend smoking hookahs§§1.9 (0.9–4.2)1.8 (1.0–3.2)*11.5 (4.4–33.0)***2.0 (0.6–7.2)5.2 (1.2–22.6)*

        Data are presented as adjusted odds ratio (95% CI). ref: reference. #: models adjusted for age, sex, migration background, school type, consumer susceptibility to interpersonal influence, socioeconomic status, sensation seeking, and e-cigarette use of at least one friend; ¶: n=6577; +: n=6531; §: n=6529; ƒ: n=6540; ##: n=6533; ¶¶: n=6532; ++: n=6575; §§: peer behaviour was omitted in some cases due to small cell frequencies, meaning that corresponding behaviour was also shown by peers. *: p<0.05; ***: p≤0.001; all models allow for nested data (p<0.05).

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        Electronic cigarette marketing and smoking behaviour in adolescence: a cross-sectional study
        Julia Hansen, Reiner Hanewinkel, Matthis Morgenstern
        ERJ Open Research Oct 2018, 4 (4) 00155-2018; DOI: 10.1183/23120541.00155-2018

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        Electronic cigarette marketing and smoking behaviour in adolescence: a cross-sectional study
        Julia Hansen, Reiner Hanewinkel, Matthis Morgenstern
        ERJ Open Research Oct 2018, 4 (4) 00155-2018; DOI: 10.1183/23120541.00155-2018
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