Association Between Receptivity to Tobacco Advertising and Progression to Tobacco Use in Youth and Young Adults in the PATH Study

John P Pierce; James D Sargent; David B Portnoy; Martha White; Madison Noble; Sheila Kealey; Nicolette Borek; Charles Carusi; Kelvin Choi; Victoria R Green; Annette R Kaufman; Eric Leas; M Jane Lewis; Katherine A Margolis; Karen Messer; Yuyan Shi; Marushka L Silveira; Kimberly Snyder; Cassandra A Stanton; Susanne E Tanski; Maansi Bansal-Travers; Dennis Trinidad; Andrew Hyland

doi:10.1001/jamapediatrics.2017.5756

. 2018 Mar 26;172(5):444–451. doi: 10.1001/jamapediatrics.2017.5756

Association Between Receptivity to Tobacco Advertising and Progression to Tobacco Use in Youth and Young Adults in the PATH Study

John P Pierce ^1,^2,^✉, James D Sargent ³, David B Portnoy ⁴, Martha White ¹, Madison Noble ^1,², Sheila Kealey ¹, Nicolette Borek ⁴, Charles Carusi ⁵, Kelvin Choi ⁶, Victoria R Green ^7,⁸, Annette R Kaufman ⁹, Eric Leas ^1,², M Jane Lewis ¹⁰, Katherine A Margolis ⁴, Karen Messer ^1,², Yuyan Shi ^1,², Marushka L Silveira ^7,⁸, Kimberly Snyder ⁴, Cassandra A Stanton ^5,¹¹, Susanne E Tanski ³, Maansi Bansal-Travers ¹², Dennis Trinidad ^1,², Andrew Hyland ¹²

¹Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California

²Department of Family Medicine and Public Health, University of California, San Diego

³C. Everett Koop Institute, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire

⁴Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland

⁵Westat, Rockville, Maryland

⁶National Institute on Minority Health and Health Disparities, Bethesda, Maryland

⁷National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland

⁸Kelly Government Solutions, Rockville, Maryland

⁹Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland

¹⁰Department of Health Education and Behavioral Science, Rutgers School of Public Health, New Brunswick, New Jersey

¹¹Department of Oncology, Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC

¹²Roswell Park Cancer Institute, Department of Health Behavior, Buffalo, New York

Accepted for Publication: December 21, 2017.

^✉

Corresponding Author: John P. Pierce, PhD, Department of Family Medicine and Public Health, Moores UC San Diego Cancer Center, 3855 Health Sciences Dr, Mail Code 0901, University of California, San Diego, La Jolla, CA 92093 (jppierce@ucsd.edu).

Published Online: March 26, 2018. doi:10.1001/jamapediatrics.2017.5756

Author Contributions: Dr Pierce had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Pierce, Sargent, Portnoy, Noble, Borek, Choi, Kaufman, Margolis, Messer, Shi, Stanton, Tanski.

Acquisition, analysis, or interpretation of data: Pierce, Sargent, Portnoy, White, Kealey, Borek, Carusi, Choi, Green, Kaufman, Leas, Lewis, Margolis, Shi, Silveira, Snyder, Stanton, Bansal-Travers, Trinidad, Hyland.

Drafting of the manuscript: Pierce, Sargent, Portnoy, Noble, Leas, Margolis, Trinidad.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Pierce, Portnoy, White, Choi, Leas, Shi, Bansal-Travers.

Obtained funding: Pierce, Borek, Messer, Hyland.

Administrative, technical, or material support: Portnoy, Noble, Borek, Green, Margolis, Snyder, Stanton, Trinidad, Hyland.

Study supervision: Pierce, Portnoy, Margolis, Messer.

Conflict of Interest Disclosures: None reported.

Funding/Support: This article was supported with Federal funds from the National Institute on Drug Abuse (NIDA), National Institutes of Health, and the Center for Tobacco Products, US Food and Drug Administration (FDA), Department of Health and Human Services, under contract HHSN271201100027C to Westat.

Role of the Funders/Sponsors: Staff from the NIDA and the FDA contributed to the design and conduct of the study; management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; and the decision to submit the manuscript for publication. The NIDA and the FDA were not directly involved in the collection of study data. The data for the PATH Study were collected and prepared by Westat.

Disclaimer: The views and opinions expressed in this article are those of the authors only and do not necessarily represent the views, official policy, or position of the US Department of Health and Human Services or any of its affiliated institutions or agencies.

^✉

Corresponding author.

PMCID: PMC5875336 PMID: 29582078

Key Points

Question

Is receptivity to advertising of e-cigarettes, cigarettes, cigars, and smokeless tobacco products a risk factor for trying tobacco products in youth and young adults?

Findings

In this population-based study including 10 989 participants, receptivity to tobacco advertising at wave 1 was significantly associated with committed never tobacco users aged 12 to 17 years progressing to susceptibility and tobacco product use at 1-year follow-up in wave 2. For never tobacco users aged 12 to 21 years at wave 1, receptivity to e-cigarette advertising was significantly associated with ever use of conventional cigarettes at wave 2.

Meaning

Receptivity to tobacco product advertising is associated with progression to tobacco use among young never tobacco users, and receptivity to e-cigarette marketing is associated with later conventional cigarette smoking.

Abstract

Importance

Cigarette marketing contributes to initiation of cigarette smoking among young people, which has led to restrictions on use of cigarette advertising. However, little is known about other tobacco advertising and progression to tobacco use in youth and young adults.

Objective

To investigate whether receptivity to tobacco advertising among youth and young adults is associated with progression (being a susceptible never user or ever user) to use of the product advertised, as well as conventional cigarette smoking.

Design, Setting, and Participants

The Population Assessment of Tobacco and Health (PATH) Study at wave 1 (2013-2014) and 1-year follow-up at wave 2 (2014-2015) was conducted in a US population-based sample of never tobacco users aged 12 to 24 years from wave 1 of the PATH Study (N = 10 989). Household interviews using audio computer-assisted self-interviews were conducted.

Exposures

Advertising for conventional cigarettes, electronic cigarettes (e-cigarettes), cigars, and smokeless tobacco products at wave 1.

Main Outcomes and Measures

Progression to susceptibility or ever tobacco use at 1-year follow-up in wave 2.

Results

Of the 10 989 participants (5410 male [weighted percentage, 48.3%]; 5579 female [weighted percentage, 51.7%]), receptivity to any tobacco advertising at wave 1 was high for those aged 12 to 14 years (44.0%; 95% confidence limit [CL], 42.6%-45.4%) but highest for those aged 18 to 21 years (68.7%; 95% CL, 64.9%-72.2%). e-Cigarette advertising had the highest receptivity among all age groups. For those aged 12 to 17 years, susceptibility to use a product at wave 1 was significantly associated with product use at wave 2 for conventional cigarettes, e-cigarettes, cigars, and smokeless tobacco products. Among committed never users aged 12 to 17 years at wave 1, any receptivity was associated with progression toward use of the product at wave 2 (conventional cigarettes: adjusted odds ratio [AOR], 1.43; 95% CL, 1.23-1.65; e-cigarettes: AOR, 1.62; 95% CL, 1.41-1.85; cigars: AOR, 2.01; 95% CL, 1.62-2.49; and smokeless [males only]: AOR, 1.42; 95% CL, 1.07-1.89) and with use of the product (conventional cigarettes: AOR, 1.54; 95% CL, 1.03-2.32; e-cigarettes: AOR, 1.45; 95% CL, 1.19-1.75; cigars: AOR, 2.07; 95% CL, 1.26-3.40). Compared with those not receptive to any product advertising, receptivity to e-cigarette advertising, but not to cigarette advertising, was independently associated with those aged 12 to 21 years having used a cigarette at wave 2 (AOR, 1.60; 95% CL, 1.08-2.38).

Conclusions and Relevance

Receptivity to tobacco advertising was significantly associated with progression toward use in adolescents. Receptivity was highest for e-cigarette advertising and was associated with trying a cigarette.

This population-based study examines the association between advertising for tobacco products and later use of the products in adolescents and young adults.

Introduction

The US Surgeon General¹ has concluded that cigarette advertising promotes the initiation of cigarette smoking. In the United States, 82% of adult smokers try their first cigarette before age 18 years and 93% before age 21 years,¹^(p238) which is the minimum age to purchase tobacco in 2 states and in more than 215 localities.² Within 4 years of first smoking, 30% to 50% of adolescents progress to established use^3,4; the associated dependence continues for many years.^3,4,5 Restrictions on cigarette marketing introduced in 1998⁶ coincided with the start of a long-term decline in high school seniors ever smoking (65%-28% in 2016).⁷ Exposure to marketing of noncigarette tobacco products (particularly electronic cigarettes [e-cigarettes]) has grown rapidly,^8,9,10 as has use of these products.^{11,12,13,14,15} As e-cigarette advertising models vaping, a behavior similar to cigarette smoking, it has been hypothesized that e-cigarette advertising could promote conventional cigarette smoking.^16,17

The initiation process has been best described for cigarette smoking. In the United States, progression from being a committed never smoker begins with the development of a cognitive susceptibility to smoke in late childhood/adolescence¹⁸ followed by trial and increased frequency of use.^1,4,10 Effective marketing encourages product use with messages that elicit a positive (receptive) response from those viewing the advertisement.¹⁹ Communication and advertising theories^20,21 propose levels of receptivity with higher levels more predictive of future use. Receptivity to cigarette advertising increases the probability that committed never smokers will become susceptible and then try a cigarette (ie, progress toward use).^{10,16,17,22,23} In this article, we report whether this pattern holds across other tobacco products.

The Population Assessment of Tobacco and Health (PATH) Study measured receptivity to advertising for cigarettes, e-cigarettes, smokeless tobacco, and cigars among respondents aged 12 to 24 years at wave 1.²⁴ As first use is mainly complete by age 21 years, we report whether receptivity among never users also peaks by age 21 years. Because individuals can be receptive to advertising for multiple products, we report the most frequent combinations across tobacco products. Because the PATH Study measured susceptibility only among participants aged 12 to 17 years at wave 1, we use this subpopulation to test whether susceptibility to use of each product at wave 1 is associated with product use at 1-year follow-up in wave 2 and examine how receptivity to product advertising indicates progression toward product use. Finally, among those most at risk of starting smoking (individuals aged 12-21 years), we explore whether receptivity to e-cigarette advertising was significantly associated with trying a conventional cigarette at wave 2.

Methods

Participants and Procedures

Data were collected in the PATH Study,²⁵ a nationally representative, longitudinal study of the noninstitutionalized, civilian US population aged 12 years or older. Details of the study design are presented elsewhere.^26,27 The PATH Study oversampled adult tobacco users, young adults (aged 18-24 years), and African American adults. Participants were selected using data collected from an in-person household screener. Audio computer-assisted self-interviews in English or Spanish collected self-report information on tobacco-use patterns and associated health behavior. Population and replicate weights adjust for the study design characteristics and nonresponse at waves 1 and 2.

The PATH Study was conducted by Westat, a contract research organization, and approved by its institutional review board, and the study plan and procedures were approved by the Office of Management and Budget. Written informed consent was obtained from adult respondents and written assent was obtained from youth after written informed consent from a parent. The study provided incentives to thank respondents for participating in the study.²⁵

Wave 1 interviews were conducted from September 12, 2013, to December 14, 2014; the weighted response rate for the household screener was 54.0%. Among screened households, the overall weighted response rate at wave 1 was 74.0% for the adult interview (n = 32 320) and 78.4% for the youth interview (age 12-17 years, n = 13 651). Wave 2 interviews were conducted as close as possible to the 1-year anniversary of each respondent’s wave 1 interview (weighted response rate: adult interview, 83.2%; youth interview, 87.3%).^26,27

Measures

Ever Use of Tobacco Products

Both waves of the adult and youth questionnaires asked respondents if they had ever used a cigarette, even 1 or 2 puffs. Respondents were shown separate pictures for e-cigarettes, various types of cigars, smokeless tobacco, pipe, hookah, dissolvable products, and bidis and/or kreteks and asked if they had ever seen or heard of each. Those who responded positively were asked whether they had ever used the product, even 1 or 2 times. This study included only respondents aged 12 to 24 years who answered negatively to all tobacco product use questions at wave 1 for cigarettes, e-cigarettes, cigars, and smokeless tobacco products (N = 10 989; 5410 male [weighted percentage, 48.3%]; 5579 female [weighted percentage, 51.7%]). At wave 2, respondents were shown pictures for the same tobacco products and similarly queried on use. One difference from wave 1 was that e-cigarette use was expanded to include other electronic nicotine products, such as e-cigars, e-pipes, e-hookahs, personal vaporizers, vape pens, and hookah pens. We considered all of these as electronic nicotine delivery systems (ENDS) and e-cigarette variations.

Susceptibility to Use Tobacco Products

To determine susceptibility of future use,¹⁷ we identified committed never users (ie, those considered at minimum risk of future use) and categorized all others as susceptible. For cigarettes and other tobacco products that a respondent had seen or heard of, never users aged 12 to 17 years were asked 3 questions at wave 1: “Have you ever been curious about using <product>?”; “Do you think you might try using <product> soon?”; and “If one of your best friends were to offer you <product>, would you use it?” Four-level responses ranged from not at all curious to very curious, or from definitely not to definitely yes. Respondents with the strongest negative response to all 3 questions and respondents who had never heard of the product were categorized as committed never users. All other respondents were categorized as susceptible to use the product, including those with missing responses. Susceptibility was not queried among participants aged 18 to 24 years at wave 1 but was among those aged 12 to 24 years at wave 2.

Receptivity to Tobacco Product Advertising

The PATH Study assessed receptivity at wave 1 based on favorite ads, recall, and liking ads.²⁴ Respondents were asked to select the brand of their favorite tobacco advertisement from a list. We allocated favorite brands to 1 of the 4 categories (cigarettes, e-cigarettes, cigars, or smokeless tobacco products). Unless snus was specifically mentioned, we assumed that nomination of Marlboro or Camel referred to cigarettes.

Each respondent was then shown 20 ads (5 from each study category) randomly sampled from a near-census collection (n = 959) of print, direct mail, and television ads used in the period immediately preceding the survey.²⁴ For each ad shown, respondents were asked if they had seen the ad in the past 12 months (aided recall) and whether they liked, disliked, or were neutral to the ad (eFigure in the Supplement). Receptivity to ads for each product type was categorized as (1) no receptivity (no recall or liking of any of the 5 ads and no favorite ad), (2) low receptivity (recall of at least 1 shown ad but no liking of any ad and no favorite), or (3) moderate/high receptivity (liking at least 1 of the ads or naming a favorite ad). Any receptivity was a combination of categories 2 and 3. Respondents could be receptive to ads for multiple products. We report data for combinations of ads for conventional cigarettes, e-cigarettes, and other products (eg, smokeless and cigars).

Other Variables

Assessments of age, sex, and race/ethnicity are provided in the PATH Study Data User Guide.^26,27 Missing self-report data were replaced by data from the household screener sex (n = 26), age (n = 2), race (n = 473), and ethnicity (n = 187). As these variables were important for weighting, any remaining missing data were statistically imputed (eg, race, n = 135).²⁷ To address our age 21-years hypothesis and to be comparable with previous work,²⁴ we categorized age at wave 1 as 12 to 14, 15 to 17, 18 to 21, and 22 to 24 years. To assess social and secondhand tobacco exposure, respondents were asked: “Does anyone who lives with you now use any of the following: <list of tobacco products>?” and “During the past 7 days, about how many hours were you around others who were smoking? Include time in your home, in a car, at school, or outdoors.” We reported binary variables of exposure for household and social exposure (0 vs ≥1 hour).

Statistical Analysis

We computed variances using the recommended balanced repeated replication method with Fay adjustment = 0.3.²⁸ Weighted percentages and modified Wilson confidence limits (CLs) for proportions were also calculated.²⁹ For each product assessed, a logistic regression among wave 1 never users of the product aged 12 to 17 years tested the association of wave 1 susceptibility with wave 2 use of the product. For each of the 4 products with receptivity data, among committed never users aged 12 to 17 years, logistic regression models tested whether wave 1 receptivity (compared with no receptivity) was associated with either ever use or progression (combined susceptibility and ever use) at wave 2. As males are much more likely to use smokeless products than females,^30,31 we repeated the smokeless models for males only. Finally, for never tobacco smokers aged 12 to 21 years, a logistic regression tested whether wave 1 receptivity to e-cigarette advertising was associated with ever using a cigarette at wave 2. Logistic regressions included wave 1 covariates for sociodemographics and both household and social exposure to tobacco use. Odds ratios, 95% CLs, and P values were reported from the weighted, adjusted model. All analyses were conducted using SAS SURVEY procedures, version 9.4 (SAS Institute).

Results

Receptivity to Advertising for Different Tobacco Products by Age at Wave 1

The proportion of individuals with any level of receptivity to any tobacco ad increased significantly across successive age groups up to 21 years (nonoverlapping 95% CLs), from 44.0% for those aged 12 to 14 years to 68.7% for those aged 18 to 21 years, with receptivity among the 22- to 24-year group closer to that of the 15- to 17-year group (Table 1). For all age groups through 21 years, any receptivity was highest for e-cigarette ads, followed by cigarette, smokeless tobacco, and cigar ads. This pattern of a progressively greater proportion that was receptive to any product advertisement up to age 21 years was most marked for moderate/high receptivity: those aged 18 to 21 years were almost 3 times more likely to have moderate/high receptivity compared with those aged 12 to 14 years (27.5% vs 9.7%). Any vs no receptivity levels for covariates are presented in the eTable in the Supplement.

Table 1. Receptivity to Ads for Different Tobacco Products by Age Among Never Tobacco Users: Population Assessment of Tobacco and Health Study Wave 1, 2013-2014^a.

Characteristic	Age, % (95% CL)
Characteristic	12-14 y	15-17 y	18-21 y	22-24 y
Sample size, No. (%) [SE]	5567 (37.8) [0.4]	3924 (27.9) [0.3]	1008 (21.6) [0.5]	490 (12.7) [0.6]
Receptive to cigarette ads
Low	19.0 (17.8-20.3)	18.3 (16.9-19.8)	29.5 (26.4-32.7)	22.7 (19.0-26.9)
Moderate/high	3.8 (3.1-4.5)	7.1 (6.3-8.0)	13.7 (11.4-16.3)	17.8 (14.2-22.1)
Any	22.8 (21.4-24.1)	25.4 (23.9-27.0)	43.1 (39.6-46.7)	40.5 (35.4-45.8)
Receptive to e-cigarette ads
Low	25.8 (24.5-27.1)	27.7 (26.2-29.1)	34.8 (31.5-38.2)	27.7 (23.6-32.2)
Moderate/high	3.9 (3.4-4.5)	5.2 (4.4-6.2)	12.1 (9.8-14.9)	11.3 (8.8-14.4)
Any	29.7 (28.5-31.0)	32.9 (31.1-34.6)	47.0 (43.5-50.5)	39.0 (34.1-44.1)
Receptive to cigar ads
Low	7.4 (6.7-8.2)	8.4 (7.5-9.3)	17.2 (14.7-20.0)	10.7 (8.1-14.1)
Moderate/high	1.6 (1.3-2.0)	3.2 (2.7-3.9)	8.2 (6.2-10.8)	9.7 (7.2-12.8)
Any	9.0 (8.3-9.8)	11.6 (10.6-12.7)	25.4 (22.3-28.8)	20.4 (16.9-24.4)
Receptive to smokeless ads
Low	13.4 (12.5-14.4)	15.4 (14.1-16.7)	21.3 (18.2-24.7)	16.3 (12.7-20.6)
Moderate/high	2.8 (2.3-3.4)	4.7 (4.0-5.5)	11.8 (9.7-14.3)	13.1 (10.0-17.0)
Any	16.2 (15.1-17.4)	20.1 (18.7-21.5)	33.1 (29.7-36.7)	29.4 (24.8-34.4)
Receptive to any tobacco ads^b
Low	34.3 (32.8-35.7)	34.6 (32.9-36.3)	41.2 (37.8-44.7)	34.3 (30.1-38.7)
Moderate/high	9.7 (8.8-10.7)	14.8 (13.5-16.1)	27.5 (24.2-31.0)	29.1 (24.9-33.7)
Any	44.0 (42.6-45.4)	49.3 (47.6-51.1)	68.7 (64.9-72.2)	63.3 (57.7-68.6)

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Abbreviation: CL, confidence limit.

^{^a}

Percentages and 95% CLs are weighted estimates.

^{^b}

Indicates receptivity to ads for cigarettes, e-cigarettes, cigars, or smokeless tobacco products.

Receptivity to Combinations of Tobacco Product Advertising Among Never Tobacco Users Aged 12 to 24 Years

Of those with receptivity to a tobacco ad, 68.4% had low receptivity, although most were receptive to advertising for multiple products (Table 2). Receptivity to the most prevalent combinations of tobacco product advertising was (1) cigarettes alone (23.2%), (2) e-cigarettes alone (33.3%), (3) both cigarettes and e-cigarettes (33.9%), and (4) any other combinations (9.7%). Thus, of those who had any level of receptivity to any product ad, 67.2% were receptive to e-cigarette ads and 57.1% were receptive to cigarette ads.

Table 2. Receptivity to Combinations of Tobacco Product Ads Among Never Tobacco Users Aged 12 to 14 Years With Receptivity to Any Product in Population Assessment of Tobacco and Health Study Wave 1, 2013-2014 (n = 5409).

Tobacco Product Ad^a^,^b	% (95% CL)^b
Tobacco Product Ad^a^,^b	Low Receptivity	Moderate/High Receptivity	Any Receptivity
Cigarettes (Without e-Cigarettes)
Receptive only to cigarette ads	9.6 (8.7-10.5)	4.0 (3.3-4.8)	13.6 (12.5-14.7)
Receptive to cigarette ads and other products but not e-cigarette ads	6.1 (5.4-7.0)	3.5 (2.9-4.2)	9.6 (8.7-10.5)
Subtotal	15.7 (14.5-17.0)	7.5 (6.6-8.5)	23.2 (21.8-24.6)
e-Cigarettes (Without Cigarettes)
Receptive only to e-cigarette ads	20.3 (19.0-21.8)	2.4 (2.0-3.0)	22.8 (21.4-24.2)
Receptivity to e-cigarette ads and other products but not cigarette ads	6.7 (6.0-7.5)	3.7 (3.1-4.5)	10.5 (9.5-11.6)
Subtotal	27.1 (25.6-28.6)	6.2 (5.4-7.1)	33.3 (31.7-34.9)
Cigarettes and e-Cigarettes
Receptive to both cigarette and e-cigarette advertising, but not other product advertising	6.4 (5.6-7.3)	3.0 (2.4-3.8)	9.5 (8.4-10.6)
Receptive to both cigarette and e-cigarette with other product advertising	13.6 (12.4-14.9)	10.8 (9.7-12.1)	24.5 (23.1-25.9)
Subtotal	20.0 (18.6-21.5)	13.9 (12.7-15.2)	33.9 (32.3-35.6)
Other Products
Receptive only to other tobacco product advertising but not cigarette or e-cigarette ads	5.6 (4.8-6.5)	4.0 (3.3-5.0)	9.7 (8.7-10.8)
Total	68.4 (66.6-70.2)	31.6 (29.8-33.4)	100

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Abbreviation: CL, confidence limit.

^{^a}

Other products are cigars and smokeless products.

^{^b}

Percentages and 95% CLs are weighted estimates.

Susceptibility at Wave 1 and Progression Toward Product Use at Wave 2

Among never tobacco users aged 12 to 17 years, we ran a series of multivariable logistic regressions on the association between susceptibility to use each product at wave 1 and ever use of that product at wave 2 (Figure). Susceptibility to use was significantly associated with wave 2 use for each of the products for which receptivity was measured: conventional cigarettes (AOR, 3.66; 95% CL, 2.79-4.81), e-cigarettes (AOR, 3.55; 95% CL, 3.08-4.09), cigars (AOR, 4.36; 95% CL, 3.26-5.81), and smokeless products (AOR, 5.01; 95% CL, 3.32-7.56). Among the age 12- to 24-year group (n = 1187), at wave 2, 66.2% of those who had tried ENDS products had used an e-cigarette; e-hookah (49.5%) was the only other product with substantial ever use (percentages are weighted). Confining our analysis of ENDS products to only those who used e-cigarettes at wave 2 did not change our findings.

Figure. — Adjusted odds ratios for ever use of product at wave 2. Adjusted for age, sex, race/ethnicity, and exposure to tobacco users. Vertical bar is a visual reference to the odds ratio = 1.0 line; when confidence limits (CLs) cross this line, they are not significantly different from the reference. Error bars indicate 95% CLs.

Receptivity to Tobacco Advertising at Wave 1 and Progression Toward Use at Wave 2

Among committed never users of each product aged 12 to 17 years at wave 1, we used multivariable logistic models to test whether any receptivity to each product’s advertising at wave 1 was associated with (1) ever use of the product at wave 2 or (2) progression toward use (ie, susceptibility plus ever use) at wave 2 (Table 3). Receptivity to advertising at wave 1 was associated with ever use of the product at wave 2 for conventional cigarettes, e-cigarettes, and cigars, but not smokeless tobacco, either overall or for males only. Receptivity was also associated with the larger proportion of committed never users who progressed toward use (including those who became susceptible at wave 2) for conventional cigarettes (25.5% vs 19.0%), e-cigarettes (35.5% vs 24.6%), and cigars (31.7% vs 17.8%), although not for smokeless tobacco (10.8% vs 9.2%). The e-cigarette results included all ENDS products, but findings were similar when restricted to e-cigarettes and for smokeless tobacco for males only.

Table 3. Association of Receptivity Among Committed Never Tobacco Users Aged 12 to 17 Years at Wave 1 With Progression and Ever Use in Wave 2, 2014-2015, in Population Assessment of Tobacco and Health Study^a.

Wave 1 Variables		Sample	Progression Status at Wave 2, % (SE)^b			AOR (95% CL)
Product	Receptivity to Product at Wave 1	No. (%) [SE]	Susceptible at Wave 2	Ever Use at Wave 2	Any Progression^b	Any Progression at Wave 2^b	Ever Use at Wave 2
Cigarette model	None	5240 (79.6) [0.5]	17.4 (0.6)	1.6 (0.2)	19.0 (0.6)	1 [Reference]	1 [Reference]
Cigarette model	Any	1378 (20.4) [0.5]	22.6 (1.2)	2.9 (0.5)	25.5 (1.3)	1.43 (1.23-1.65)	1.54 (1.03-2.32)
e-Cigarette model	None	5085 (73.8) [0.6]	18.4 (0.6)	6.2 (0.4)	24.6 (0.7)	1 [Reference]	1 [Reference]
e-Cigarette model	Any	1866 (26.2) [0.6]	26.2 (1.2)	9.2 (0.7)	35.5 (1.2)	1.62 (1.41-1.85)	1.45 (1.19-1.75)
Cigar model	None	7551 (91.5) [0.3]	16.0 (0.5)	1.9 (0.2)	17.8 (0.6)	1 [Reference]	1 [Reference]
Cigar model	Any	742 (8.5) [0.3]	27.6 (1.7)	4.1 (0.9)	31.7 (2.0)	2.01 (1.62-2.49)	2.07 (1.26-3.40)
Smokeless model	None	7253 (83.8) [0.5]	8.4 (0.4)	0.8 (0.1)	9.2 (0.4)	1 [Reference]	1 [Reference]
Smokeless model	Any	1409 (6.2) [0.5]	9.6 (0.8)	1.2 (0.3)	10.8 (1.0)	1.21 (0.96-1.52)	1.35 (0.68-2.70)
Smokeless model (males only)	None	3657 (85.1) [0.7]	9.2 (0.6)	1.2 (0.2)	10.4 (0.6)	1 [Reference]	1 [Reference]
Smokeless model (males only)	Any	647 (14.9) [0.7]	11.7(1.3)	2.4 (0.7)	14.1 (1.5)	1.42 (1.07-1.89)	1.69 (0.81-3.55)

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Abbreviations: AOR, adjusted odds ratio; CL, confidence limit.

^{^a}

All models adjusted for sex (except the smokeless model for males), race/ethnicity, age, and exposure to use in household and social settings. Percentages, ORs, and confidence limits are weighted estimates.

^{^b}

Progression is a committed never user at wave 1 who is either susceptible to use or has ever used the product at wave 2.

Receptivity to e-Cigarette Advertising at Wave 1 and Ever Using a Conventional Cigarette at Wave 2

Among never tobacco users aged 12 to 21 years at wave 1, we conducted a multivariable logistic regression of those who had ever used a cigarette at wave 2. Table 4 presents the results for the main combinations of receptivity to tobacco product advertising outlined in Table 2. Compared with those who were not receptive to advertisements for any tobacco product, those who were receptive only to conventional cigarette advertising at wave 1 were significantly more likely to have ever used a conventional cigarette at wave 2, as were those who were receptive to advertising for both conventional cigarettes and e-cigarettes. Those who were receptive to e-cigarette advertising, but not receptive to conventional cigarette advertising, were also more likely to have ever used a conventional cigarette at wave 2 compared with those with no receptivity.

Table 4. Association of Any Receptivity to e-Cigarette and Cigarette Ads at Wave 1 With Ever Smoking at Wave 2 Among Never Tobacco Users Aged 12 to 21 Years in the Population Assessment of Tobacco and Health Study^a.

Any Receptivity at Wave 1	% (SE)		AOR (95% CL)
Any Receptivity at Wave 1	Population	Wave 2 Ever Cigarette Users	AOR (95% CL)
No receptivity to any product	48.2 (0.7)	2.6 (0.3)	1 [Reference]
Receptive to cigarette ads, not e-cigarette ads	11.4 (0.4)	5.9 (0.9)	1.89 (1.30-2.75)
Receptive to e-cigarette ads, not cigarette ads	17.8 (0.5)	4.9 (0.8)	1.60 (1.08-2.38)
Receptive to both cigarette and e-cigarette ads	17.2 (0.5)	6.5 (0.8)	1.98 (1.34-2.92)
Other receptivity, not including cigarettes or e-cigarettes^b	5.4 (0.3)	4.5 (1.1)	1.45 (0.84-2.51)

Open in a new tab

Abbreviations: AOR, adjusted odds ratio; CL, confidence limit.

^{^a}

Adjusted for sex, race/ethnicity, age, exposure to use in household and social settings. Percentages, ORs, and 95% CLs are weighted estimates.

^{^b}

Other products include smokeless tobacco and cigars.

Discussion

Susceptibility to conventional cigarettes, e-cigarettes, cigars, and smokeless tobacco at wave 1 was associated with ever use of that product by wave 2 and is thus an early measure of progression toward product use. Between wave 1 and 2 of the nationally representative PATH Study, there was considerable progression toward use of tobacco products among the aged 12- to 21-years group. Receptivity to advertising for each of the 4 tested products was associated with progression toward use of the advertised product. In 2013 to 2014, 44% of never tobacco users aged 12 to 14 years were receptive to advertising for at least 1 tobacco product. Among committed never e-cigarette users aged 12 to 17 years at wave 1, 36% of those who were receptive to e-cigarette advertising progressed toward e-cigarette use at wave 2 compared with 25% of those who were not receptive. Similarly, any receptivity was associated with progression toward use in the age 12- to 17-year group of conventional cigarettes (25.5% vs 19%), cigars (31.7% vs 17.8%), and smokeless tobacco for males (14.1% vs 10.4%). Receptivity was also associated with first use within the year for each product, except smokeless tobacco (which may be a small sample size issue). The crossover effect is important: receptivity to e-cigarette advertising without concurrent receptivity to cigarette advertising was associated with never tobacco users trying a conventional cigarette by wave 2.

Although the majority (66.2%) of ENDS users at wave 2 had used an e-cigarette, almost half reported use of e-hookah, suggesting that ENDS products might be perceived to be versions of the same product category. Accordingly, this study considers any ENDS use as e-cigarette use. We repeated our analyses using only those who progressed to e-cigarettes and, as this did not change our findings, kept the inclusive definition of e-cigarettes as any ENDS product at wave 2. Multiple longitudinal studies have shown a positive association between e-cigarette use by youth and later conventional cigarette smoking.^{32,33,34,35,36} These findings suggest a hypothesis that initial exposure to nicotine can lead individuals to look for a more efficient product that provides satisfaction. Our study of never tobacco users suggests a role for an environmental influence in that the effectiveness of e-cigarette advertising contributes to the association between e-cigarette use and conventional cigarette smoking.

First use of a tobacco product typically starts before age 21 years¹ and a number of jurisdictions have recently proscribed purchase of tobacco products before that age. The PATH Study measured receptivity to tobacco advertising among youth aged 12 to 24 years and we report that, across products, receptivity peaks by age 21 years. The approach to measuring receptivity was the most comprehensive of any study to date, with each respondent viewing 20 ads sampled for each respondent from a near-census of ads used in the previous year.

Strengths and Limitations

A limitation is that the PATH Study did not specifically include either online or social media marketing ad images; however, as tobacco ads are typically used on multiple media channels, our measure of receptivity likely included exposure to ads appearing on social media. More research is needed on this topic. A strength of the PATH Study is that data were collected from a nationally representative, household-based sample and that participants completed multiple surveys over time. At wave 2, the study retained over 83% of wave 1 participants. Susceptibility to use a product was not measured for those aged 18 to 24 years in wave 1, but relevant hypotheses may be addressed in future articles using waves 2 and 3 data. Furthermore, the wave 1 ever use rate for those aged 12 to 17 years was lower than for some other national surveys, which may be a survey mode effect.³⁷ Later waves did not include the ad receptivity measure, so we were unable to consider the effect of consistency in receptivity reporting across time.

Conclusions

Receptivity to tobacco product advertising is substantial among US youth who are below the minimum required age to purchase tobacco products. Among young committed never users, receptivity is significantly associated with progression toward use within a 1-year period. With 1 exception, likely related to study power, having any level of receptivity to a product’s advertisements at wave 1 was associated with both progression toward use and ever use of the product at wave 2. Further research can examine why e-cigarette advertising was associated with trying a cigarette. Our study reinforces that tobacco product marketing continues to be an important contributor to tobacco use among young people.

Supplement.

eTable. Receptivity to Any Tobacco Advertising Among Never-Users of Tobacco by Covariates in Table 3

eFigure. PATH Study Wave 1 Tobacco Advertising Questions and Sample of Tobacco Advertising Image

Click here for additional data file.^{(1MB, pdf)}

References

1.US Department of Health and Human Services Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health; 2012. [Google Scholar]
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3.Choi WS, Gilpin EA, Farkas AJ, Pierce JP. Determining the probability of future smoking among adolescents. Addiction. 2001;96(2):313-323. [DOI] [PubMed] [Google Scholar]
4.Choi WS, Pierce JP, Gilpin EA, Farkas AJ, Berry CC. Which adolescent experimenters progress to established smoking in the United States. Am J Prev Med. 1997;13(5):385-391. [PubMed] [Google Scholar]
5.Chassin L, Presson CC, Sherman SJ, Edwards DA. The natural history of cigarette smoking: predicting young-adult smoking outcomes from adolescent smoking patterns. Health Psychol. 1990;9(6):701-716. [DOI] [PubMed] [Google Scholar]
6.Pierce JP, Gilpin EA. How did the Master Settlement Agreement change tobacco industry expenditures for cigarette advertising and promotions? Health Promot Pract. 2004;5(3)(suppl):84S-90S. [DOI] [PubMed] [Google Scholar]
7.Wadley J, Lee J Vaping, hookah use by US teens declines for first time [press release]. Ann Arbor, MI. 2016. http://ns.umich.edu/new/releases/24386-vaping-hookah-use-by-us-teens-declines-for-first-time.
8.Singh T, Agaku IT, Arrazola RA, et al. . Exposure to advertisements and electronic cigarette use among US middle and high school students. Pediatrics. 2016;137(5):pii:e20154155. [DOI] [PMC free article] [PubMed] [Google Scholar]
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10.Strong DR, Messer K, Hartman SJ, et al. . Pre-adolescent receptivity to tobacco marketing and its relationship to acquiring friends who smoke and cigarette smoking initiation. Ann Behav Med. 2017;51(5):730-740. [DOI] [PMC free article] [PubMed] [Google Scholar]
11.Giovenco DP, Casseus M, Duncan DT, Coups EJ, Lewis MJ, Delnevo CD. Association between electronic cigarette marketing near schools and e-cigarette use among youth. J Adolesc Health. 2016;59(6):627-634. [DOI] [PubMed] [Google Scholar]
12.Timberlake DS. Advertising receptivity and youth initiation of smokeless tobacco. Subst Use Misuse. 2016;51(9):1077-1082. [DOI] [PMC free article] [PubMed] [Google Scholar]
13.Mantey DS, Cooper MR, Clendennen SL, Pasch KE, Perry CL. e-Cigarette marketing exposure is associated with e-cigarette use among US youth. J Adolesc Health. 2016;58(6):686-690. [DOI] [PMC free article] [PubMed] [Google Scholar]
14.Choi WS, Farkas AJ, Rosbrook B, Elder JP, Pierce JP. Does advertising promote smokeless tobacco use among adolescent boys? evidence from California. Tob Control. 1995;4:S57-S63. [Google Scholar]
15.Nicksic NE, Harrell MB, Pérez A, Pasch KE, Perry CL. Recall of e-cigarette advertisements and adolescent e-cigarette use. Tob Regul Sci. 2017;3(2):210-221. [DOI] [PMC free article] [PubMed] [Google Scholar]
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19.Brusselmans G, Blasberg J, Root J The Biggest Contributor to Brand Growth. Bain & Co. Bain Brief. http://www.bain.com/publications/articles/the-biggest-contributor-to-brand-growth.aspx. Published March 19, 2014. Accessed March 7, 2017.
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21.Ray ML. Marketing Communication and the Hierarchy-of-Effects. Cambridge, MA: Marketing Science Institute; 1973. [Google Scholar]
22.Pierce JP, Choi WS, Gilpin EA, Farkas AJ, Merritt RK. Validation of susceptibility as a predictor of which adolescents take up smoking in the United States. Health Psychol. 1996;15(5):355-361. [DOI] [PubMed] [Google Scholar]
23.Pierce JP, Distefan JM, Kaplan RM, Gilpin EA. The role of curiosity in smoking initiation. Addict Behav. 2005;30(4):685-696. [DOI] [PubMed] [Google Scholar]
24.Pierce JP, Sargent JD, White MM, et al. . Receptivity to tobacco advertising and susceptibility to tobacco products. Pediatrics. 2017;139(6):pii:e20163353. [DOI] [PMC free article] [PubMed] [Google Scholar]
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27.United States Department of Health and Human Services; National Institutes of Health; National Institute on Drug Abuse; United States Department of Health and Human Services; Food and Drug Administration; Center for Tobacco Products Population Assessment of Tobacco and Health (PATH) Study 2013. [United States] Restricted-Use Files User Guide. ICPSR 36231. 10.3886/ICPSR36498.v6. Updated 2017. Accessed December 10, 2017. [DOI]
28.SAS 9.4: today and tomorrow [computer program]. Cary, NC: SAS Institute Inc; 2016.
29.SAS 9.3 system options: reference [computer program]. Cary, NC: SAS Institute Inc; 2011.
30.US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings (NSDUH series H-48, HHS Publication No (SMA) 14-4863) [press release]. Rockville, MD: Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf. Published September 2014. Accessed March 3, 2017.
31.Nelson DE, Mowery P, Tomar S, Marcus S, Giovino G, Zhao L. Trends in smokeless tobacco use among adults and adolescents in the United States. Am J Public Health. 2006;96(5):897-905. [DOI] [PMC free article] [PubMed] [Google Scholar]
32.Barrington-Trimis JL, Urman R, Berhane K, et al. . E-cigarettes and future cigarette use. Pediatrics. 2016;138(1):e20160379. [DOI] [PMC free article] [PubMed] [Google Scholar]
33.Leventhal AM, Strong DR, Kirkpatrick MG, et al. . Association of electronic cigarette use with initiation of combustible tobacco product smoking in early adolescence. JAMA. 2015;314(7):700-707. [DOI] [PMC free article] [PubMed] [Google Scholar]
34.Wills TA, Knight R, Sargent JD, Gibbons FX, Pagano I, Williams RJ. Longitudinal study of e-cigarette use and onset of cigarette smoking among high school students in Hawaii. Tob Control. 2017;26(1):34-39. [DOI] [PMC free article] [PubMed] [Google Scholar]
35.Spindle TR, Hiler MM, Cooke ME, Eissenberg T, Kendler KS, Dick DM. Electronic cigarette use and uptake of cigarette smoking: a longitudinal examination of US college students. Addict Behav. 2017;67:66-72. [DOI] [PMC free article] [PubMed] [Google Scholar]
36.Conner M, Grogan S, Simms-Ellis R, et al. . Do electronic cigarettes increase cigarette smoking in UK adolescents? Evidence from a 12-month prospective study. [published online August 17, 2017]. Tob Control. 2017. [DOI] [PMC free article] [PubMed] [Google Scholar]
37.Biglan M, Gilpin EA, Rohrbach LA, Pierce JP. Is there a simple correction factor for comparing adolescent tobacco-use estimates from school- and home-based surveys? Nicotine Tob Res. 2004;6(3):427-437. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplement.

eTable. Receptivity to Any Tobacco Advertising Among Never-Users of Tobacco by Covariates in Table 3

eFigure. PATH Study Wave 1 Tobacco Advertising Questions and Sample of Tobacco Advertising Image

Click here for additional data file.^{(1MB, pdf)}

[poi170117r1] 1.US Department of Health and Human Services Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health; 2012. [Google Scholar]

[poi170117r2] 2.Campaign for Tobacco Free Kids. Increasing the minimum legal sale age for tobacco products to 21; 2017. https://www.tobaccofreekids.org/what_we_do/state_local/sales_21. Updated December 4, 2017. Accessed December 10, 2017.

[poi170117r3] 3.Choi WS, Gilpin EA, Farkas AJ, Pierce JP. Determining the probability of future smoking among adolescents. Addiction. 2001;96(2):313-323. [DOI] [PubMed] [Google Scholar]

[poi170117r4] 4.Choi WS, Pierce JP, Gilpin EA, Farkas AJ, Berry CC. Which adolescent experimenters progress to established smoking in the United States. Am J Prev Med. 1997;13(5):385-391. [PubMed] [Google Scholar]

[poi170117r5] 5.Chassin L, Presson CC, Sherman SJ, Edwards DA. The natural history of cigarette smoking: predicting young-adult smoking outcomes from adolescent smoking patterns. Health Psychol. 1990;9(6):701-716. [DOI] [PubMed] [Google Scholar]

[poi170117r6] 6.Pierce JP, Gilpin EA. How did the Master Settlement Agreement change tobacco industry expenditures for cigarette advertising and promotions? Health Promot Pract. 2004;5(3)(suppl):84S-90S. [DOI] [PubMed] [Google Scholar]

[poi170117r7] 7.Wadley J, Lee J Vaping, hookah use by US teens declines for first time [press release]. Ann Arbor, MI. 2016. http://ns.umich.edu/new/releases/24386-vaping-hookah-use-by-us-teens-declines-for-first-time.

[poi170117r8] 8.Singh T, Agaku IT, Arrazola RA, et al. . Exposure to advertisements and electronic cigarette use among US middle and high school students. Pediatrics. 2016;137(5):pii:e20154155. [DOI] [PMC free article] [PubMed] [Google Scholar]

[poi170117r9] 9.Padon AA, Maloney EK, Cappella JN. Youth-Targeted E-cigarette Marketing in the US. Tob Regul Sci. 2017;3(1):95-101. [DOI] [PMC free article] [PubMed] [Google Scholar]

[poi170117r10] 10.Strong DR, Messer K, Hartman SJ, et al. . Pre-adolescent receptivity to tobacco marketing and its relationship to acquiring friends who smoke and cigarette smoking initiation. Ann Behav Med. 2017;51(5):730-740. [DOI] [PMC free article] [PubMed] [Google Scholar]

[poi170117r11] 11.Giovenco DP, Casseus M, Duncan DT, Coups EJ, Lewis MJ, Delnevo CD. Association between electronic cigarette marketing near schools and e-cigarette use among youth. J Adolesc Health. 2016;59(6):627-634. [DOI] [PubMed] [Google Scholar]

[poi170117r12] 12.Timberlake DS. Advertising receptivity and youth initiation of smokeless tobacco. Subst Use Misuse. 2016;51(9):1077-1082. [DOI] [PMC free article] [PubMed] [Google Scholar]

[poi170117r13] 13.Mantey DS, Cooper MR, Clendennen SL, Pasch KE, Perry CL. e-Cigarette marketing exposure is associated with e-cigarette use among US youth. J Adolesc Health. 2016;58(6):686-690. [DOI] [PMC free article] [PubMed] [Google Scholar]

[poi170117r14] 14.Choi WS, Farkas AJ, Rosbrook B, Elder JP, Pierce JP. Does advertising promote smokeless tobacco use among adolescent boys? evidence from California. Tob Control. 1995;4:S57-S63. [Google Scholar]

[poi170117r15] 15.Nicksic NE, Harrell MB, Pérez A, Pasch KE, Perry CL. Recall of e-cigarette advertisements and adolescent e-cigarette use. Tob Regul Sci. 2017;3(2):210-221. [DOI] [PMC free article] [PubMed] [Google Scholar]

[poi170117r16] 16.Nodora J, Hartman SJ, Strong DR, et al. . Curiosity predicts smoking experimentation independent of susceptibility in a US national sample. Addict Behav. 2014;39(12):1695-1700. [DOI] [PMC free article] [PubMed] [Google Scholar]

[poi170117r17] 17.Strong DR, Hartman SJ, Nodora J, et al. . Predictive validity of the expanded susceptibility to smoke index. Nicotine Tob Res. 2015;17(7):862-869. [DOI] [PMC free article] [PubMed] [Google Scholar]

[poi170117r18] 18.Messer K, Pierce JP. Changes in age trajectories of smoking experimentation during the California Tobacco Control Program. Am J Public Health. 2010;100(7):1298-1306. [DOI] [PMC free article] [PubMed] [Google Scholar]

[poi170117r19] 19.Brusselmans G, Blasberg J, Root J The Biggest Contributor to Brand Growth. Bain & Co. Bain Brief. http://www.bain.com/publications/articles/the-biggest-contributor-to-brand-growth.aspx. Published March 19, 2014. Accessed March 7, 2017.

[poi170117r20] 20.McGuire WJ. Personality and attitude change: An information-processing theory In: Greenwald AG, Brock TC, Ostrom TM, eds. Psychological Foundations of Attitudes. New York, NY: Academic; 1968:171-196. [Google Scholar]

[poi170117r21] 21.Ray ML. Marketing Communication and the Hierarchy-of-Effects. Cambridge, MA: Marketing Science Institute; 1973. [Google Scholar]

[poi170117r22] 22.Pierce JP, Choi WS, Gilpin EA, Farkas AJ, Merritt RK. Validation of susceptibility as a predictor of which adolescents take up smoking in the United States. Health Psychol. 1996;15(5):355-361. [DOI] [PubMed] [Google Scholar]

[poi170117r23] 23.Pierce JP, Distefan JM, Kaplan RM, Gilpin EA. The role of curiosity in smoking initiation. Addict Behav. 2005;30(4):685-696. [DOI] [PubMed] [Google Scholar]

[poi170117r24] 24.Pierce JP, Sargent JD, White MM, et al. . Receptivity to tobacco advertising and susceptibility to tobacco products. Pediatrics. 2017;139(6):pii:e20163353. [DOI] [PMC free article] [PubMed] [Google Scholar]

[poi170117r25] 25.Hyland A, Ambrose BK, Conway KP, et al. . Design and methods of the Population Assessment of Tobacco and Health (PATH) Study. Tob Control. 2017;26(4):371-378. [DOI] [PMC free article] [PubMed] [Google Scholar]

[poi170117r26] 26.United States Department of Health and Human Services; National Institutes of Health; National Institute on Drug Abuse; United States Department of Health and Human Services; Food and Drug Administration; Center for Tobacco Products Population Assessment of Tobacco and Health (PATH) Study [United States] Restricted-Use Files. ICPSR 36231. 10.3886/ICPSR36231.v13. Updated 2017. Accessed December 10, 2017. [DOI]

[poi170117r27] 27.United States Department of Health and Human Services; National Institutes of Health; National Institute on Drug Abuse; United States Department of Health and Human Services; Food and Drug Administration; Center for Tobacco Products Population Assessment of Tobacco and Health (PATH) Study 2013. [United States] Restricted-Use Files User Guide. ICPSR 36231. 10.3886/ICPSR36498.v6. Updated 2017. Accessed December 10, 2017. [DOI]

[poi170117r28] 28.SAS 9.4: today and tomorrow [computer program]. Cary, NC: SAS Institute Inc; 2016.

[poi170117r29] 29.SAS 9.3 system options: reference [computer program]. Cary, NC: SAS Institute Inc; 2011.

[poi170117r30] 30.US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings (NSDUH series H-48, HHS Publication No (SMA) 14-4863) [press release]. Rockville, MD: Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf. Published September 2014. Accessed March 3, 2017.

[poi170117r31] 31.Nelson DE, Mowery P, Tomar S, Marcus S, Giovino G, Zhao L. Trends in smokeless tobacco use among adults and adolescents in the United States. Am J Public Health. 2006;96(5):897-905. [DOI] [PMC free article] [PubMed] [Google Scholar]

[poi170117r32] 32.Barrington-Trimis JL, Urman R, Berhane K, et al. . E-cigarettes and future cigarette use. Pediatrics. 2016;138(1):e20160379. [DOI] [PMC free article] [PubMed] [Google Scholar]

[poi170117r33] 33.Leventhal AM, Strong DR, Kirkpatrick MG, et al. . Association of electronic cigarette use with initiation of combustible tobacco product smoking in early adolescence. JAMA. 2015;314(7):700-707. [DOI] [PMC free article] [PubMed] [Google Scholar]

[poi170117r34] 34.Wills TA, Knight R, Sargent JD, Gibbons FX, Pagano I, Williams RJ. Longitudinal study of e-cigarette use and onset of cigarette smoking among high school students in Hawaii. Tob Control. 2017;26(1):34-39. [DOI] [PMC free article] [PubMed] [Google Scholar]

[poi170117r35] 35.Spindle TR, Hiler MM, Cooke ME, Eissenberg T, Kendler KS, Dick DM. Electronic cigarette use and uptake of cigarette smoking: a longitudinal examination of US college students. Addict Behav. 2017;67:66-72. [DOI] [PMC free article] [PubMed] [Google Scholar]

[poi170117r36] 36.Conner M, Grogan S, Simms-Ellis R, et al. . Do electronic cigarettes increase cigarette smoking in UK adolescents? Evidence from a 12-month prospective study. [published online August 17, 2017]. Tob Control. 2017. [DOI] [PMC free article] [PubMed] [Google Scholar]

[poi170117r37] 37.Biglan M, Gilpin EA, Rohrbach LA, Pierce JP. Is there a simple correction factor for comparing adolescent tobacco-use estimates from school- and home-based surveys? Nicotine Tob Res. 2004;6(3):427-437. [DOI] [PubMed] [Google Scholar]

PERMALINK

Association Between Receptivity to Tobacco Advertising and Progression to Tobacco Use in Youth and Young Adults in the PATH Study

John P Pierce, PhD

James D Sargent, MD

David B Portnoy, PhD

Martha White, MS

Madison Noble, MPH

Sheila Kealey, MPH

Nicolette Borek, PhD

Charles Carusi, PhD

Kelvin Choi, PhD

Victoria R Green, BA

Annette R Kaufman, PhD

Eric Leas, MPH

M Jane Lewis, DrPH

Katherine A Margolis, PhD

Karen Messer, PhD

Yuyan Shi, PhD

Marushka L Silveira, BDS, PhD

Kimberly Snyder, MPH

Cassandra A Stanton, PhD

Susanne E Tanski, MD

Maansi Bansal-Travers, PhD

Dennis Trinidad, PhD

Andrew Hyland, PhD

Key Points

Question

Findings

Meaning

Abstract

Importance

Objective

Design, Setting, and Participants

Exposures

Main Outcomes and Measures

Results

Conclusions and Relevance

Introduction

Methods

Participants and Procedures

Measures

Ever Use of Tobacco Products

Susceptibility to Use Tobacco Products

Receptivity to Tobacco Product Advertising

Other Variables

Statistical Analysis

Results

Receptivity to Advertising for Different Tobacco Products by Age at Wave 1

Table 1. Receptivity to Ads for Different Tobacco Products by Age Among Never Tobacco Users: Population Assessment of Tobacco and Health Study Wave 1, 2013-2014a.

Receptivity to Combinations of Tobacco Product Advertising Among Never Tobacco Users Aged 12 to 24 Years

Table 2. Receptivity to Combinations of Tobacco Product Ads Among Never Tobacco Users Aged 12 to 14 Years With Receptivity to Any Product in Population Assessment of Tobacco and Health Study Wave 1, 2013-2014 (n = 5409).

Susceptibility at Wave 1 and Progression Toward Product Use at Wave 2

Figure. Susceptibility to Use of a Tobacco Product in Respondents Aged 12 to 17 Years at Wave 1 and Ever Use of the Product at Wave 2 in the Population Assessment of Tobacco and Health Study.

Receptivity to Tobacco Advertising at Wave 1 and Progression Toward Use at Wave 2

Table 3. Association of Receptivity Among Committed Never Tobacco Users Aged 12 to 17 Years at Wave 1 With Progression and Ever Use in Wave 2, 2014-2015, in Population Assessment of Tobacco and Health Studya.

Receptivity to e-Cigarette Advertising at Wave 1 and Ever Using a Conventional Cigarette at Wave 2

Table 4. Association of Any Receptivity to e-Cigarette and Cigarette Ads at Wave 1 With Ever Smoking at Wave 2 Among Never Tobacco Users Aged 12 to 21 Years in the Population Assessment of Tobacco and Health Studya.

Discussion

Strengths and Limitations

Conclusions

References

Associated Data

Supplementary Materials

ACTIONS

PERMALINK

RESOURCES

Similar articles

Cited by other articles

Links to NCBI Databases

Table 1. Receptivity to Ads for Different Tobacco Products by Age Among Never Tobacco Users: Population Assessment of Tobacco and Health Study Wave 1, 2013-2014^a.

Table 3. Association of Receptivity Among Committed Never Tobacco Users Aged 12 to 17 Years at Wave 1 With Progression and Ever Use in Wave 2, 2014-2015, in Population Assessment of Tobacco and Health Study^a.

Table 4. Association of Any Receptivity to e-Cigarette and Cigarette Ads at Wave 1 With Ever Smoking at Wave 2 Among Never Tobacco Users Aged 12 to 21 Years in the Population Assessment of Tobacco and Health Study^a.