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. Author manuscript; available in PMC: 2022 Aug 3.
Published in final edited form as: Health Educ Behav. 2021 Apr 6;49(4):639–646. doi: 10.1177/10901981211003867

Exposure to E-Cigarette Product Placement in Music Videos Is Associated With Vaping Among Young Adults

Anuja Majmundar 1, Jennifer B Unger 1, Tess Boley Cruz 1, Matthew G Kirkpatrick 1, Jon-Patrick Allem 1
PMCID: PMC8492787  NIHMSID: NIHMS1719045  PMID: 33821689

Abstract

Background.

The prevalence of electronic-cigarette (e-cigarette) product placement in music videos is on the rise and currently unregulated. This promotional activity is concerning given the popularity of music videos among young adults.

Aims.

We examined associations between self-reported levels of exposure to music videos with any e-cigarette product placement or imagery and susceptibility to use e-cigarettes and e-cigarette use.

Method.

A representative sample of young adults (18–24 years of age), residing in California (n = 1,280), completed online surveys assessing self-reported exposure to music videos with e-cigarette product placement or imagery and susceptibility to use e-cigarettes and e-cigarette use. Adjusted and weighted regression analyses were used for statistical analyses.

Results.

Participants exposed to any e-cigarette product placement or imagery in music videos were more likely to report lifetime e-cigarette use (relative risk ratio [RRR]: 2.81) and past 30-day use (RRR: 3.64) compared with participants with no exposure. Additionally, participants with greater levels of exposure were more likely to report lifetime e-cigarette use (RRR: 1.13) and past 30-day use (RRR: 1.20) compared with participants with lower levels of exposure. Among those with any exposure, participants younger than 21 years of age (i.e., under the tobacco purchasing age in the United States) were more likely to report lifetime e-cigarette use (RRR: 4.68) compared with those aged 21 years and older.

Discussion and Conclusion.

Restricting e-cigarette product placement or imagery in music videos may minimize marketing exposure and risk for vaping among young adults, especially among those under the tobacco purchasing age.

Keywords: e-health, population groups, quantitative methods, social media, substance use, vaping, young adults

Exposure to tobacco marketing is known to increase the awareness, appeal, perceptions of benefits and risks of use, as well as uptake and continued use of tobacco products, especially among youth (Collins et al., 2019; Cruz et al., 2018; Dal Cin et al., 2007; Dalton et al., 2003; Heatherton & Sargent, 2009; Sargent et al., 2005; Sargent et al., 2007; Song et al., 2007). The tobacco industry has previously used multiple marketing strategies, now restricted or banned, including advertisements via magazines and billboards, paid product placement in motion pictures, discount coupons, free samples, point-of-sale promotions, sponsored community events, and loyalty programs (Davis et al., 2008; National Association of Attorneys General, 2000). Unlike combustible cigarette marketing, many aspects of electronic-cigarette (e-cigarette) marketing are not restricted under the 1999 Master Settlement Agreement (National Association of Attorneys General, 2000). In 2016, while extending its regulatory authority over e-cigarettes, the U.S. Food and Drug Administration did not include further restrictions on e-cigarette marketing other than mandating health warnings on all tobacco products’ and e-cigarettes’ advertisements (U.S. Food and Drug Administration, 2016). Given the vaping epidemic among young adults (18–24 years of age) in recent years (Chadi et al., 2019), it is crucial to understand the links between exposure to e-cigarette marketing unaddressed by the current tobacco regulations and e-cigarette use.

The appearance of e-cigarettes in music videos, in particular, is on the rise (Knutzen et al., 2018). A recent editorial suggested that the company KandyPens (www.kandypens.com) employed product placement, referred to as purposeful incorporation of commercial content in music videos, in 29 music videos in a 24-month period, which collectively received hundreds of millions of views on YouTube, indicating substantial marketing reach (Allem et al., 2019). Research suggests that in 1 month YouTube receives 30 million unique visitors between the ages of 18 and 24 years (Blattberg, 2015), and sizeable portions of this audience are watching popular music videos (Blattberg, 2015). The sheer volume of e-cigarette impressions that can be delivered by music videos warrants attention by the tobacco control community.

Product placement in music videos has been known to generate increased brand recall compared with conventional advertising (Grzyb et al., 2018). By pairing e-cigarettes with appealing actors or settings, this marketing strategy could produce positive attitudes toward the brand and product use (Schemer et al., 2008). According to social cognitive theory, behaviors are learned and reinforced through observation of others’ behaviors (Bandura, 2001). Young adults exposed to e-cigarette use in music videos that feature influential musical artists, celebrities, and paid models may result in increased positive perceptions of e-cigarettes and increased susceptibility to e-cigarette use. While combustible tobacco product placement in movies and television was commonplace in the past and exposure to such product placement was associated with susceptibility to use and use of tobacco products (Mekemson & Glantz, 2002), there is limited understanding about the associations between exposure to e-cigarette product placement or imagery in music videos and susceptibility to use e-cigarettes and e-cigarette use.

This line of research is necessary because current laws do not include e-cigarette in marketing restrictions. In the United States, district attorneys, and/or lawyers from the Office of the Attorney General, and/or legislators generally require evidence of a problem before actions are taken to address the problem. For these practical reasons, the study of e-cigarette product placement in music videos that are popular among young adults is necessary. Research has shown that music videos are recommended to friends, and watched repeatedly, among young adults and that websites like YouTube facilitate video sharing and consecutive views in concentrated periods of time (Cranwell et al., 2015). As a result, seeing music videos multiple times may prime expectancy, driving participants to seek out videos again, which could have additive or reinforcing effects on attitudes and behaviors. Additionally, it took over a decade of research on the causal relationship between depictions of smoking in movies and the initiation of smoking among young persons to convince some movie studios to reduce this imagery in their films (U.S. Department of Health and Human Services, 2012) or have the Motion Picture Association of America modify their ratings of movies based on smoking imagery (Mekemson & Glantz, 2002). This self-regulation and/or regulation will not automatically extend to e-cigarettes in music videos unless research establishes that exposure to this imagery influences attitudes and behaviors. This study takes a step toward this goal by examining the associations between self-reported levels of exposure to music videos with e-cigarette product placement or imagery and susceptibility to use e-cigarettes and e-cigarette use. We hypothesized that exposure to music videos with e-cigarette product placement or imagery would be associated with (1) susceptibility to use e-cigarettes and (2) e-cigarette use.

Method

Participants and Procedures

Young adults (18–24 years of age) living in California completed a survey between August 19, 2019, and October 17, 2019 (administered by YouGov PLC). Respondents (n = 1,500) were recruited using a stratified sampling procedure. The sampling frame was constructed from the 2016 American Community Survey 1-year sample with selection within strata by weighted sampling with replacements. Respondents were then matched to the sampling frame on gender, age, race, and education, which resulted in a sample of 1,500 participants. Propensity scores were used to weight the matched cases to the sampling frame.

Sample

Of the total (n = 1,500) respondents, those who failed a data quality check (i.e., those indicating exposure to three or more “ringers” or fake music videos including a combination of nonexistent artists and song titles) were excluded from the sample (n = 160). Ringers consisted of song titles and artists that did not have music videos as well as fake song titles and artists. Next, observations with missing data on outcome or explanatory variables were excluded (n = 60 participants, 4.48% of initial sample). The final analytic sample of the study was composed of 1,280 participants (see Figure 1 for details). Missing data analysis revealed that there were no significant differences in the sample characteristics of the analytic sample (n = 1,280) and the excluded sample (n = 60). See Supplemental eTable 2 (available in the online version of this article) for missing data analysis. The study was approved by the institutional review board of the authors’ university. All participants provided written informed consent.

Figure 1.

Figure 1.

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Data management procedures.

Measures

Explanatory Measures.

Participants were asked to indicate whether they had seen any of the 24 music videos based on the title and artist(s) shown on the screen. Twenty videos were actual music videos that prior research had identified as containing e-cigarette product placement or imagery (Allem et al., 2019; Escobedo et al., 2020), and four videos were ringers. Refer to the Supplemental eMethods 1 (available in the online version of this article) for further details on music video titles. There were two variables assessing aspects of exposure to music videos with e-cigarette product placement or imagery. These were operationalized in terms of a dichotomized exposure (Yes/No) and degree of exposure (0–20 videos). For the dichotomized exposure variable, participants reporting seeing at least one of the 20 music videos with product placement or imagery were categorized as exposed. Those indicating that they had not come across even one of the videos before were categorized as not exposed. The degree of exposure variable was determined based on a sum of responses indicating exposure to the 20 videos. The decision to include 20 music videos was informed by prior work (Cranwell et al., 2015; Cranwell et al., 2016).

Covariates.

Demographic covariates included age (18–20 years of age, 21 years and older) defined in terms of California’s legal smoking and tobacco product purchasing age, gender (female, male, and other), race/ethnicity (Asian, Black, Hispanic, Latino/Latina, Non-Hispanic White, and other), education (some college educated or more, high school graduate or no high school), employment (employed full-time or part-time, student, and other), and household income per approximate California’s median household income (≤$70,000 per year, >$70,000 per year, and income not disclosed).

Additional covariates included exposure to off-line (Yes/No) and online tobacco advertising (Yes/No), drawn from the Centers for Disease Control and Prevention’s National Youth Tobacco Survey. Three separate questions measured exposure to advertisements of a range of e-cigarette products in newspapers or magazines, billboards, convenience stores, supermarkets, or gas stations. Responses indicating that the participants were “never” exposed to any product advertising across all three questions were coded as “No” or not exposed to off-line tobacco advertising. All other responses indicating “rarely,” “sometimes,” “most of the time,” or “always” to at least one of the products were coded as “Yes” or exposed to off-line tobacco advertising. The same categorization rule was applied to one question assessing exposure to online advertising.

Ever use to at least one or more tobacco products (Yes/No), adapted from the Population Assessment of Tobacco Health, was also included as a covariate. Use of at least one or more tobacco products (cigarettes, cigars, cigarillos or little cigars, hookahs, chewing tobacco, snuff or dip, pipe tobacco, or other products) was coded as “Yes.” Responses indicating “I don’t know” to any of these questions were marked as missing. See Supplemental eMethods 1 for more details on survey questions.

Outcome Measures

E-cigarette use.

E-cigarette use was measured in terms of never users, past 30-day users, and lifetime users. Participants responding with “no” to the question about having tried vaping (even one or two puffs of at least one of the following products: disposable device, vape pen or pen-like device, rechargeable device such as eGO or small startup kit, mod or mech-mod rechargeable device, box mod, Juul, other pod mod, and another type of electronic nicotine device) in the past were categorized as “never users.” Past 30-day users were those who responded with “yes” to the above initial question and “yes” to past 30-day use. Lifetime users were those who responded with “yes” to the initial question and “no” to past 30-day use (Barrington-Trimis et al., 2018). Responses indicating “I don’t know” in any of these questions were marked as missing.

Susceptibility to use e-cigarettes.

Similar to previous tobacco-related research (Pierce et al., 1996), three separate questions measuring susceptibility were administered to those who had reported never having used e-cigarettes in the past. The questions pertained to whether they were curious about vaping, their likelihood of vaping soon, and whether they would try vaping if a friend offered them an e-cigarette. Also, in line with previous research (Chuang et al., 2017; Pierce et al., 2005), responses to these questions were coded into a dichotomous variable such that responses “definitely no” or “not at all curious” to all three questions were coded as “not susceptible to use e-cigarettes.’ At least one or more response to other items were coded as “susceptible to use e-cigarettes.”

Statistical Analysis.

Multinomial logistic regression was used to assess the relationship between exposure to music videos and e-cigarette use. Logistic regression assessed the relationship between exposure to music videos and susceptibility to use e-cigarettes among never users. To determine whether those under the tobacco purchasing age were more likely to report exposure to e-cigarette product placement or imagery and e-cigarette use, an interaction between age and exposure was included in the models. All analyses were weighted to California’s population estimates and controlled for covariates described above. We report the relative risk ratios, odds ratios, 95% confidence interval, and p value associated with the outcome variables. A level of significance of α ≤ .05 was used in all statistical analyses. Reported p values are two sided. Weighted analyses were conducted in Stata 14.

Results

Demographic Characteristics

About 57.20% of participants were 21 years of age or older, and 49.57% were males (see Table 1 for weighted and unweighted estimates of the sample). About 42.50% of participants were employed, and 62.42% of participants had a family income of less than $70,000 per year. About 29.53% of participants were Hispanic, 32.32% were non-Hispanic White, 11.34% Asian, and 5.02% Black. About 50.25% of participants reported using a tobacco product (excluding vape pen products) in their lifetime, while 75.86% reported being exposed to at least one tobacco product ad online, with 97.29% of participants reporting being exposed to at least one tobacco product ad off-line. Participants recalled an average of 3.94 music videos (SD = 3.92).

Table 1.

Sample Characteristics.

Characteristic Raw, n (%) Weighted, n (%)
Age
 18–20 years 534 (41.72) 544.07 (42.51)
 21 years and over 746 (58.28) 736.76 (57.20)
Gender
 Female 705 (55) 602.30 (47.06)
 Male 528 (41.25) 634.56 (49.57)
 Other 47 (3.67) 43.14 (3.37)
Education
 Some college educated or more 834 (65.15) 758.29 (59.24)
 High school graduate or no high school 446 (34.84) 521.71 (40.76)
Race/ethnicity
 Asian 164 (12.81) 145.14 (11.34)
 Black 83 (6.48) 64.28 (5.02)
 Hispanic 297 (23.20) 377.95 (29.53)
 Latino/Latina 167 (13.05) 193.44 (15.11)
 White (non-Hispanic) 461 (36.02) 413.68 (32.32)
 Other 108 (8.44) 85.50 (6.68)
Employment
 Employed 554 (43.28) 544.05 (42.50)
 Student 467 (36.48) 467.53 (36.53)
 Other 259 (20.23) 268.41 (20.97)
Family income
 ≤$70,000 778 (60.78) 798.95 (62.42)
 >$70,000 322 (25.16) 311.29 (24.32)
 Not disclosed 180 (14.06) 169.76 (13.26)
Tobacco product ever use
 Yes 653 (51.02) 643.19 (50.25)
 No 627 (48.98) 636.81 (49.75)
Exposure to at least one tobacco product ad online
 Yes 982 (76.72) 971.04 (75.86)
 No 298 (23.28) 308.95 (24.14)
Exposure to at least one tobacco product ad off-line
 Yes 1,253 (97.89) 1245.37 (97.29)
 No 27 (2.11) 34.63 (2.71)
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Association Between Exposure to E-Cigarette Product Placement or Imagery in Music Videos, Susceptibility to Use E-Cigarettes, and E-Cigarette Use

Adjusted logistic regression analysis revealed that participants exposed to any e-cigarette product placement or imagery in music videos were more likely to report lifetime e-cigarette use (relative risk ratio [RRR]: 2.81) and past 30-day use (RRR: 3.64) compared with participants with no exposure. Participants with greater levels of exposure were more likely to report lifetime e-cigarette use (RRR: 1.13) and past 30-day use (RRR: 1.20) compared with participants with lower levels of exposure. Self-reported exposure to music video product placement or imagery was not significantly associated with susceptibility to use e-cigarettes among never users. See Table 2 for more details.

Table 2.

Adjusted and Weighted Regression Analyses of Self-Reported Exposure to Product Placement Videos.

Self-reported exposure to music videos with
e-cigarette product placement or imagery
 Degree of self-reported exposure to music videos with
e-cigarette product placement or imagery
All participants
 Interaction effects with agea
 All participants
 Interaction effects with agea
Category OR/RRR [95% CI] p OR/RRR [95% CI] p OR/RRR [95% CI] p OR/RRR [95% CI] p
Susceptibility to use e-cigarettes (n = 576) 1.31 [0.85, 2.01] .22 1.35 [0.60, 3.02] .45 1.03 [0.97, 1.10] .33 0.99 [0.88, 1.12] .92
E-cigarette useb (n = 1,280)
Lifetime users 2.81 [1.72, 4.59] .001* 4.68 [1.92, 1 1.37] .001* 1.13 [1.06, 1.19] .001* 1.10 [0.90, 1.13] .92
Past 30-day users 3.64 [2.19, 6.04] .001* 3.62 [1.32, 9.88] .40 1.20 [1.13, 1.27] .001* 1.004 [1.01, 1.12] .91
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Note. RRR = relative risk ratio; OR = odds ratio.

a

Reference category: participants aged 21 years and over.

b

Reference category: never users.

*

p < .05.

Age Interactions

There was a significant interaction effect between any self-reported exposure to e-cigarette product placement or imagery in music videos and age such that among those with any exposure participants younger than 21 years of age were more likely to report lifetime e-cigarette use compared with their older counterparts (aged 21 years or older; RRR: 4.68). There was no significant interaction between degree of self-reported exposure to e-cigarette product placement or imagery in music videos and age. See Table 2 and Figure 2 for more details.

Figure 2.

Figure 2.

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Interaction effects of exposure to any e-cigarette product placement and age.

Discussion

Findings suggest that exposure to e-cigarette product placement or imagery in music videos was associated with higher likelihood of lifetime and past 30-day e-cigarette use among young adults in California. Among those exposed to music videos with e-cigarette product placement, those younger than 21 years of age were more likely to report lifetime use of the products than their older counterparts. By demonstrating associations between exposure to music videos with e-cigarette product placement or imagery and e-cigarette use, this study addresses a crucial gap in the literature.

Previous research has characterized the occurrence of e-cigarette product placement in music videos (Cranwell et al., 2016; Knutzen et al., 2018), but the downstream associations of exposure with attitudes and behaviors remained unknown until now. The current findings indicate that mere exposure to e-cigarette product placement in music videos is linked to increased likelihood of e-cigarette use. The significant dose-response relationship between exposure and product use further clarifies the implications of such targeted marketing strategies: Individuals with the greatest amount of exposure to this marketing strategy are at the greatest risk for use of e-cigarettes.

Music videos are often watched on YouTube, a popular social media platform among young adults (Pew Research Center, 2019b), which is also known to feature extensive tobacco-related content (Freeman & Chapman, 2007) and product promotions (Schwemmer & Ziewiecki, 2018). YouTube also offers opportunities to engage with its content by sharing, liking, following, rewatching, and commenting on the videos. The platform’s recommendation algorithm also progressively exposes users to longer videos (Pew Research Center, 2019a), potentially reinforcing or intensifying effects on attitudes and behaviors. In sum, the potential reach, engagement, and reinforcing effects of e-cigarette product placement or imagery in music videos may contribute to a further increase in vaping among young adults, warranting urgent consideration in tobacco control efforts.

Product placement in music videos is shown to be an effective marketing strategy that combines advertising and entertainment (referred to as “advertainment”; Kretchmer, 2004). In fact, an experimental study revealed that even when participants were made aware of product placement through disclosures, it was associated with positive attitudes toward the brand (Matthes & Naderer, 2016). While examining differential exposure of such marketing among those younger than 21 years of age, and those 21 years of age and older (legally permissible age for tobacco purchase in the United States), findings inform regulatory efforts to minimize risk of exposure among youth. Exposure to e-cigarette product placement is concerning especially among those aged less than 21 years of age. Restricting product placement in music videos or incorporation of explicit disclosures of e-cigarette product placement in music videos may play a crucial role in minimizing marketing exposure among young adults. These findings could motivate district attorneys situated in cities like Los Angeles, where music videos are produced, or state attorney generals’ offices to investigate e-cigarette product placement in music videos popular among those under the legal tobacco purchasing age.

However, this study’s findings should be considered with several limitations in mind. Findings may not be generalizable to young adults residing outside of California. The analysis is based on self-reported exposure and may be subject to recall bias. However, to address false reporting of exposure to music videos, we excluded participants reporting exposure to ringer videos. The survey data were collected from a 4-week period (August 19, 2019, to October 17, 2019) and may not extend to other points in time. It is also possible that the susceptibility measure, originally validated in a sample of adolescents (Pierce et al., 1996), is more sensitive among adolescents than young adults, which may potentially explain the nonsignificant association between exposure and susceptibility. This study could not determine a causal relationship between exposure to product placement or imagery in music videos and e-cigarette use; however, this is an area of future research.

Conclusion

Exposure to music videos with e-cigarette product placement or imagery was associated with higher likelihood of e-cigarette use among young adults. Participants younger than 21 years of age and exposed to music videos with e-cigarette product placement were more likely to report lifetime use of e-cigarettes than never use compared with those who are 21 years or older. These findings warrant urgent attention for tobacco control. Restricting e-cigarette product placement in music videos may minimize marketing exposure among young adults in the future.

Supplementary Material

Supplemental material for Exposure to E-Cigarette Product Placement in Music Videos Is Associated With Vaping Among Young Adults

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was partially supported by funds provided by The Regents of the University of California, Research Grants Program Office, Tobacco-Related Diseases Research Program, Grant Number No. 28KT-0003. The opinions, findings, and conclusions herein are those of the authors and do not necessarily represent those of The Regents of the University of California or any of its programs. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online at http://journals.sagepub.com/home/heb.

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Supplementary Materials

Supplemental material for Exposure to E-Cigarette Product Placement in Music Videos Is Associated With Vaping Among Young Adults
NIHMS1719045-supplement-Supplemental_material_for_Exposure_to_E-Cigarette_Product_Placement_in_Music_Videos_Is_Associated_With_Vaping_Among_Young_Adults.docx (26.4KB, docx)

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