Noticing People, Discounts, and Non-Tobacco Flavors in E-cigarette Ads May Increase E-cigarette Product Appeal among Non-Tobacco-Using Young Adults

Abstract

Introduction.

Young adults new to tobacco (including e-cigarettes) are at an increased risk of e-cigarette use after e-cigarette exposure. This study examined the association between noticing e-cigarette advertising features and perceived product appeal among non-tobacco-using young adults.

Methods.

A sample of non-tobacco-using young adults (ages 18-29 years; n=1,993) completed an online survey in 2021. We content analyzed visible features from twelve e-cigarette ads that represented commonly used e-cigarette brands. Participants viewed the ads and clicked on the areas of the ads that drew their attention. Participants reported e-cigarette product appeal for each ad, including ad liking, product curiosity, and use interest. We used generalized estimating equations to examine within-person associations between noticing specific ad features and reporting each and any type of product appeal, adjusting for noticing other features and participant characteristics.

Results.

Noticing people, discounts, non-tobacco (menthol and mint/fruit) flavors, positive experience claims, or product images was positively associated with having any e-cigarette product appeal. Noticing discounts or mint/fruit flavors was also positively associated with e-cigarette use interest. In contrast, noticing nicotine warnings or smoking cessation claims was negatively associated with ad liking and product curiosity.

Conclusions.

Attention to several e-cigarette ad features (e.g., people, discounts, non-tobacco flavors) was associated with increased e-cigarette product appeal, whereas attention to nicotine warnings and smoking cessation claims was associated with reduced appeal among non-tobacco-using young adults. Restricting appeal-promoting features while strengthening the effects of nicotine warnings and smoker-targeted claims in e-cigarette ads may potentially reduce e-cigarettes’ overall appeal among this priority population.

INTRODUCTION

Young adults are a priority population for research on e-cigarette use and prevention strategies.¹ The uptake of e-cigarette product use among young adults has increased in the U.S. in recent years.² Specifically, e-cigarette use prevalence among young adults (ages 18-24) increased from 5.1% to 9.3% between 2014 and 2019.^3,4 Additionally, young adults have become even more likely than adolescents to initiate e-cigarettes.⁵ This trend is concerning, given that e-cigarette use during young adulthood can lead to nicotine addiction and may increase the risks for developing more harmful tobacco use behaviors, which can lead to respiratory diseases, cardiovascular diseases, and cancers later in life.⁶

An important risk factor for e-cigarette initiation and continued use for young adults is e-cigarette marketing exposure.^7-10 Young adults have been historically targeted by tobacco industry product marketing, and today, they continue to be exposed to high levels of tobacco marketing.^11-13 For example, a study found that 74% of U.S. young adults (ages 18-24 years) who had never used tobacco products before were exposed to e-cigarette ads in the past month, and those who were exposed were about three times as likely to initiate e-cigarette use one year later compared to those who were not exposed.⁸ Similarly, a randomized controlled trial found that among a national sample of young adults (ages 18-34 years) naïve to e-cigarettes, those who were exposed to e-cigarette ads were about three times as likely to initiate e-cigarette use six months later compared to those who were not exposed.⁹

Although a large body of research has explored the overall influence of e-cigarette marketing on e-cigarette perceptions and use among young adults,^7-10 less evidence is available to demonstrate which features of e-cigarette advertising are particularly influential in promoting e-cigarette appeal and trial. An understanding of the influence of e-cigarette advertising at the feature level is critical to combat tobacco industry strategies which may use certain ad features to increase product appeal by design. The hierarchy-of-effects in advertising model suggests that advertising exposure may cause product use through ad features that create positive norms and appeals about the products.¹⁴ Certain e-cigarette advertising features, such as sweet flavors and attractive people, may be especially impactful in increasing perceived product appeal among young adults. While the U.S. Food and Drug Administration (FDA), which regulates e-cigarette products, may not completely eliminate e-cigarette advertising due to commercial speech rights afforded by the First Amendment of the U.S. Constitution¹⁵ it does take marketing plans and potential for youth appeal into consideration when making decisions on e-cigarette premarket tobacco product applications (PMTAs). Therefore, understanding the influence of specific advertising features among tobacco-naïve populations may be especially important for the FDA’s enforcement and authorization of e-cigarette products.

To address those research gaps and inform policymaking, this study examined attention to the features of e-cigarette ads and its association with perceived e-cigarette product appeal among young adults who had never used tobacco products or had only experimented with tobacco products before. We hypothesized that certain e-cigarette advertising features may increase e-cigarette product appeal while others may reduce the appeal among the target population. We focused on non-tobacco-using young adults for this study rather than tobacco-using young adults, as identifying strategies and policies for e-cigarette use prevention among this group may significantly reduce future harm and health consequences.¹

METHODS

Study Eligibility and Recruitment

Between April and July 2021, we recruited participants from online panels administered by Qualtrics to participate in an online survey. Eligibility to participate included being between 18 and 29 years old and being either a never tobacco user or a tobacco experimenter. Tobacco experimenters were defined as those who self-reported that they had tried tobacco before but had never regularly used tobacco and were currently not using tobacco at all.¹⁶ In the survey, tobacco products were defined as one of the following: cigarettes, e-cigarettes, large or premium cigars, cigarillos or filtered cigars, hookah (including waterpipe and shisha), smokeless tobacco (including snus and nicotine pouches), and heated tobacco products. Participants received invitations to this research project and were compensated with points that could be redeemed for cash. The National Institutes of Health’s Institutional Review Board approved this study (#000385).

Study Procedure

After providing informed consent, participants completed the survey. They responded to questions about their sociodemographic background and tobacco use history, and then were shown 12 static images of e-cigarette ads in a random order (see Figure 1 for examples). All e-cigarette ads selected for this study came from magazines or direct emails published by e-cigarette companies between 2019 and 2020. Those published in magazines (n=5) were obtained from Kantar Media Intelligence, while those published in direct emails (n=7) were obtained from Trinkets and Trash, a tobacco marketing surveillance archive (trinketsandtrash.org). The 12 ads selected for this study all marketed cartridge- or pod-based e-cigarettes and represented a variety of commonly used brands (e.g., JUUL, Blu, Vuse, and Logic).¹⁷

Figure 1. Example E-cigarette Ads Stimuli Used for the Study.

Sources: Kantar Media Intelligence and Trinket & Trash of Rutgers University

These 12 ads (see Figure 1) were selected because they all included more than three distinct content features (defined as a discernable component of the ads), which allowed participants to view multiple features per ad. All e-cigarette ads were double coded (86% coding agreement) by study team members based on a codebook constructed to include an exhaustive list of visible features shown in the ads (see Table 1 for a full list of features and content). Any inconsistencies were resolved by a third coder. The 14 features that appeared in at least three of the 12 ads were named directly after the content of the features (e.g., “discount,” “menthol flavor”). The features that appeared in fewer than three of the 12 ads were collapsed into the “Other Features” category. On average, each e-cigarette ad contained six different features. After coding and defining the content features, we identified the locations of the features in each ad by using Qualtrics heat map questions where we preselected the feature-containing regions and assigned their corresponding feature names.

Table 1.

Description of E-cigarette Ads Features

E-cigarette Features	Description of the Features	Number of Ads1 Containing the Feature
People	People or human models shown in the ads	8
Tobacco Flavor	Tobacco flavors in product description or on packages	6
Menthol Flavor	Menthol flavors in product description or on packages	5
Mint/fruit Flavor	Mint or fruit flavors (e.g., strawberry, cherry, melon) in product description or on packages	4
Brand	Brand names displayed in ads or on packages such as JUUL, Vuse, and Logic	9
Discount	Discount information such as “$5 off,” “15% off,” or discounted bundles	3
Other Promotions	Other product promotions such as “Buy one get one free” or giving out free products	6
Purchasing Information	Information including product sales website, shopping code, or other product purchasing-related information	6
Nicotine Warning	Warning statement displayed in the ads or on packages related to the harm of nicotine use (“This product contains nicotine. Nicotine is an addictive chemical.”)	6
Smoking Cessation Claim	Marketing claims and descriptors that target cigarette smokers and promote using e-cigarettes for smoking cessation and switching to e-cigarettes	7
Positive Experience Claim	Marketing claims and descriptors that promote positive experience and outcomes (e.g., positive recreational, social, and sensory outcomes) from using e-cigarettes	4
Product Image	Images of e-cigarette products (including pods and refillable liquids) displayed in the ads or on packages	10
No Sales to Minors	Statements related to no sales to underage minors (e.g., “Not for sale to minors.”)	5
Other Features	Any other noticeable features not mentioned above (e.g., e-cigarette company slogans, item package quantity, etc.)	8

^1.Total number of ads used in the study is 12

During the heat map task,^18-20 participants viewed each e-cigarette ad for as long as they liked, before self-reporting visual attention to various ad features. Specifically, participants were asked to click on the areas of the ads that they noticed, following the instruction, “Please look at the following images and point your cursor and click on the areas of the image you look at.” Predetermined regions were not visible to participants and did not restrict their clicking during the task but allowed for the subsequent analysis of participants’ clicks by feature. We assessed advertising features that received visual attention (i.e., the process of selective attention) rather than all features contained in the ads because only the attention-grabbing features are likely to alter cognitive processing, recall, and perceptions about e-cigarette products and their use.^21,22 On average, participants took 14.8 seconds (SD=1.9) to view each e-cigarette ad and complete the task. After viewing each ad, participants were shown three questions related to e-cigarette product appeal specific to that ad.

Measures of Noticing E-cigarette Ads Features

Noticing specific e-cigarette ad features was coded as “yes” or “no.” Only the first three areas that the participants clicked on were recorded and analyzed as “yes,” as the locations of the initial fixations are important indicators of attention and subjective preference.²³ If the participants did not click on certain pre-specified features or the click was not recorded, then attention to this particular feature was coded as “no.” On occasions where certain features were not included in a particular ad, “no” was also coded.

Measures of E-cigarette Product Appeal

Measures of e-cigarette product appeal were liking of the ad (referred to as ad liking), curiosity about the product in the ad (referred to as product curiosity), and interest in using the product (referred to as use interest).²⁴ Ad liking was adapted from the Population Assessment of Tobacco and Health (PATH) Study,²⁵ while product curiosity and use interest were adapted from the Expanded Susceptibility to Smoke Index.^26,27 Specifically, ad liking was assessed using the question “How much did you like the ad”²⁴ on a 5-point scale: (1) dislike very much, (2) dislike, (3) neither dislike nor like, (4) like, and (5) like very much. Product curiosity and use interest were assessed by asking participants to indicate how much they agreed with the statements “This ad made me curious about the product” and “This ad made me want to use the product.”²⁴ Agreement for both statements was assessed on a 5-point scale: (1) strongly disagree, (2) disagree, (3) neither agree nor disagree, (4) agree, and (5) strongly agree. All three product appeal measures were dichotomized as 0 for neutral responses (neither agree nor disagree, neither dislike nor like) and negative responses (strongly disagree, disagree, dislike very much, dislike) and 1 for positive responses (agree, strongly agree, like very much, like).²⁴ Similarly, any positive responses toward ad liking, product curiosity, or use interest were combined into a “yes” category to capture any product appeal.²⁴

Measures of Participant Characteristics

Participant characteristics measured in the study included sociodemographic characteristics (age, sex, race/ethnicity, sexual orientation, education attainment, self-perceived financial status), tobacco use environment (living with others who use tobacco, having one or more closest friends or acquaintances using tobacco),^8,16,28,29 pro-and anti-tobacco marketing message exposure,^8,16,28 and tobacco use history (ever use of e-cigarettes and other tobacco products (see Table 2 for a full list of variables and notes for a full list of tobacco products).

Table 2.

Participant Characteristics (N=1,993)

Participant Characteristics
	%
Age
18-20	23.9
21-24	34.3
25-29	41.8
Biological Sex
Female	55.8
Male	44.2
Sexual Orientation
Heterosexual	76.0
Other orientations1	24.0
Race/Ethnicity
Non-Hispanic White	64.8
Non-Hispanic Black	11.8
Hispanic	13.9
Non-Hispanic Other2	9.5
Education Level
≤High school	28.4
Some college	45.5
≥Associate degree	26.1
Subjective Financial Situation
<Live comfortably3	58.1
Live comfortably	41.9
Living with Others Who Use Tobacco4
Yes	19.4
No	80.6
Having Close Friend(s) or Acquaintance(s) Using Tobacco
Yes	45.1
No	54.9
Tobacco Marketing Exposure in the Past Six Months
Yes	78.9
No	21.1
Anti-Tobacco Message Exposure in the Past Six Months
Yes	80.8
No	19.2
Ever Using E-cigarettes
Yes	13.6
No	86.4
Ever Using Other Tobacco Products5
Yes	22.8
No	77.2

^1.“Other” category for sexual orientation includes asexual, bisexual, gay, lesbian, pansexual, queer, questioning or unsure, and other identities

^2.“Other” category for race/ethnicity includes Asians, American Indian or Alaska Native, Native Hawaiian or Pacific Islanders, and other racial groups

^3.“<Live comfortably” included categories of “met needs with a little left,” “just meet basic expenses,” and “don’t meet basic expenses”

^4.Tobacco includes e-cigarettes products.

^5.Other tobacco products included cigarettes, hookah, cigarillos or little cigars, premium or large cigars, smokeless tobacco, nicotine pouches, and heated tobacco products

Statistical Analysis

We analyzed the data using Stata 16.0 (College Station, TX) and set the statistical significance to 0.05 (2-tailed). First, we examined the frequency of participant characteristics to describe the sample. Second, we used generalized estimating equation (GEE) models to analyze the associations between noticing e-cigarette ad features and perceived e-cigarette product appeal, controlling for noticing other ad features and participant characteristics. We controlled for noticing other ad features because attention to certain features may be correlated with attention to other features that are often advertised together (e.g., non-tobacco flavors and positive experience claims). We also controlled for participant characteristics since they might be associated with both attention to ad features and perceived product appeal.

Exploratory analyses were further conducted to assess whether the associations between noticing e-cigarette ad features and e-cigarette product appeal differ among young adults from various demographic (e.g., age, biological sex, race/ethnicity) and tobacco-using (ever e-cigarette and other tobacco use) backgrounds by employing interactions terms (e.g., noticing ad feature X age) in the GEE models. Additionally, to understand whether noticing certain ad features may selectively alter e-cigarette product appeal when also noticing other features, we employed interactions terms of all possible pairs of noticing various ad features in separate GEE models (e.g., noticing discounts X noticing menthol flavor). Only any e-cigarette product appeal was used as the outcome in the interaction models to increase statistical power for detecting interaction effects. All models with interaction terms also controlled for participant characteristics and noticing other e-cigarette ad features.

For all GEE procedures, we used binomial distribution to model the log odds of perceiving the product as appealing vs. not perceiving the product as appealing. We used GEE models for this analysis because they predict population average effects and account for the nesting of multiple correlated observations (noticing ad features and perceiving e-cigarette product appeal) within individual observations.^30,31 Additionally, we tested the best working correlation structure for the GEE models using Stata’s QIC program, and chose the exchangeable correlation structure, as it was shown to be the best fit for the GEE models for this analysis.³²

RESULTS

Participant Characteristics and Perceived E-cigarette Product Appeal

The mean age of the analytical sample (n=1,993; Table 2) was 23.2 years (SD=3.5), slightly less than half of the participants (44.2%) were male, and over half of the participants (64.8%) were non-Hispanic White. Additionally, 13.6% and 22.8% of the participants had ever used e-cigarettes and other tobacco products, respectively. Overall, 34.8%, 32.8%, 14.7%, and 43.0% of participants reported ad liking, product curiosity, use interest, and any product appeal towards the e-cigarettes shown in at least one of the 12 e-cigarette ads.

Noticing E-cigarette Ad Features and Perceived E-cigarette Product Appeal

Table 3 presents the GEE model results of the associations between noticing e-cigarette ad features and product appeal, adjusting for noticing other features and all participant characteristics. The results showed that noticing people in the ads was positively associated with any product appeal, mainly driven by ad liking. Noticing discounts was positively associated with product curiosity, use interest, and any product appeal. Noticing menthol flavors was positively associated with any product appeal. Noticing mint/fruit flavors was positively associated with product curiosity, use interest, and any product appeal. Additionally, noticing positive experience claims was positively associated with ad liking, product curiosity, and any product appeal. Finally, noticing e-cigarette product images was positively associated with ad liking, product curiosity, and any product appeal. In contrast, noticing nicotine warnings was negatively associated with ad liking, product curiosity, use interest, and any product appeal; and noticing smoking cessation claims was negatively associated with ad liking, product curiosity, and any product appeal.

Table 3.

Associations Between Noticing E-cigarette Ads Features and E-cigarette Product Appeal Adjusting for Noticing Other Ads Features and Participant Characteristics^1,2

	Any Product Appeal		Ad Liking		Product Curiosity		Use Interest
	AOR	95% CI	AOR	95% CI	AOR	95% CI	AOR	95% CI
People	1.16	1.08, 1.24	1.19	1.10, 1.29	1.07	0.99, 1.17	1.05	0.93, 1.19
Brand	0.94	0.86, 1.03	0.94	0.84, 1.05	0.97	0.87, 1.09	0.89	0.75, 1.05
Discount	1.11	1.02, 1.21	1.08	0.98, 1.20	1.18	1.06, 1.30	1.17	1.01, 1.36
Other Promotions	1.01	0.91, 1.12	0.99	0.88, 1.11	1.02	0.90, 1.16	1.08	0.91, 1.29
Purchasing Information	1.00	0.91, 1.10	0.88	0.79, 0.99	1.04	0.93, 1.16	1.02	0.87, 1.20
Tobacco Flavor	0.98	0.91, 1.06	0.95	0.87, 1.03	0.99	0.90, 1.08	0.97	0.85, 1.10
Menthol Flavor	1.12	1.04, 1.21	1.06	0.97, 1.17	1.08	0.99, 1.19	1.01	0.88, 1.16
Mint/Fruit Flavor	1.15	1.04, 1.27	1.11	0.99, 1.25	1.22	1.09, 1.37	1.27	1.08, 1.50
Nicotine Warning	0.81	0.75, 0.87	0.80	0.74, 0.88	0.72	0.65, 0.79	0.65	0.56, 0.75
Smoking Cessation Claim	0.89	0.83, 0.96	0.85	0.78, 0.93	0.91	0.83, 0.99	1.01	0.89, 1.15
Positive Experience Claim	1.29	1.15, 1.47	1.35	1.18, 1.54	1.24	1.08, 1.42	0.95	0.77, 1.18
Product Image	1.09	1.02, 1.16	1.09	1.01, 1.18	1.08	1.01, 1.18	1.04	0.93, 1.16
No Sales to Minors	0.85	0.65, 1.10	0.85	0.62, 1.16	0.85	0.61, 1.18	0.80	0.49, 1.31
Other Features	1.13	1.04, 1.23	1.10	0.99, 1.22	1.26	1.14, 1.38	1.25	1.08, 1.45

^1.The GEE models simultaneously adjusted for noticing all other e-cigarette ads features and participant characteristics

^2.The bolded text indicates significance level p<0.05

Interactions Between Noticing E-cigarette Ad Features and Participant Characteristics

A few participant characteristics (e.g., biological sex, race/ethnicity) selectively altered the associations between noticing e-cigarette ad features and reporting any e-cigarette product appeal (Supplement Table 1). For example, female participants were more likely to report an increased e-cigarette appeal when noticing menthol or mint/fruit flavors in e-cigarette ads than male participants. Additionally, noticing price discounts was more likely to be associated with an increased e-cigarette product appeal among non-Hispanic Black and Hispanic participants than among other racial/ethnic groups.

Interactions Between Noticing Various E-cigarette Ad Features

The associations between noticing certain e-cigarette ad features and reporting any e-cigarette product appeal may differ when noticing other features (Supplement Table 2). For example, noticing nicotine warnings were less likely to reduce perceived e-cigarette appeal when also noticing e-cigarette products as compared to not noticing e-cigarette products. Additionally, noticing discounts increased e-cigarette product appeal only when also noticing mint/fruit flavors, and vice versa.

DISCUSSION

This is one of the first studies to examine the associations between attention to e-cigarette ad features and perceived e-cigarette product appeal among non-tobacco-using young adults. The study found that noticing people, price discounts, non-tobacco (menthol and mint/fruit) flavors, positive experience claims, and product images may increase overall perceived product appeal among this group. In particular, noticing discounts and mint/fruit flavors may increase e-cigarette product use interest, a strong predictor of future e-cigarette experimentation among young people.^26,27 Additionally, giving attention to nicotine warnings and smoking cessation claims is negatively associated with most types of product appeal among this group.

Previous research found that when exposed to e-cigarette ads, young adults spent most of their time viewing people or human models rather than other noticeable features.³³ Other evidence has suggested that attractive and fashionable young models appearing in e-cigarette ads may glorify vaping behavior among young people.^34,35 Our study further suggests that paying attention to people or human models may be associated with increased e-cigarette product appeal, largely driven by ad liking. Furthermore, our results suggest that noticing price discounts in e-cigarette ads is associated with increased e-cigarette product appeal among young adults, especially those who self-identify as non-Hispanic Black or Hispanic. Previous research has found that young people who are naïve to tobacco products are vulnerable to the marketing of reduced-priced tobacco products and are likely to initiate and continue using tobacco products, especially e-cigarettes, after noticing price promotions.^28,36,37 Therefore, there is a critical need for more research and policy discussions on strategies to regulate the use of human models and price discounts in e-cigarette marketing.

Our results further showed that giving visual attention to non-tobacco flavors, including menthol and mint/fruit flavors, may increase e-cigarette product appeal among young adults, especially female young adults. In particular, noticing mint/fruit flavors may increase young adults’ interest in using e-cigarette products, which may lead to future product trial.^26,27 Although the FDA restricted the sale of cartridge-based flavored (except for menthol) e-cigarettes in February 2020,³⁸ menthol-flavored cartridge-based e-cigarettes and flavored disposable e-cigarettes have since gained significant market share among young users in the U.S.^37,39,40 Notably, popular disposable e-cigarette brands such as Puff Bar are currently marketed with a variety of youth-appealing flavors such as Banana Ice and Mango.⁴¹ Therefore, the FDA may need to take further action to avoid the initiation and escalation of e-cigarette use among tobacco-naïve young people that may result from the continued marketing and sales of menthol and mint/fruit e-cigarette flavors.

In contrast, the results suggest that nicotine warnings are a noticeable feature on e-cigarette ads that have the potential to diminish ad liking, product curiosity, and use interest related to e-cigarette products. In 2016, the FDA mandated e-cigarette nicotine warnings on various marketing channels such as print magazines, email correspondence, and social media.⁴² Previous research has found that characteristics of e-cigarette nicotine warnings, such as content, size, color, and label design, may exert various levels of influence on perceived warning effectiveness and on individuals’ perceived harm, intention to try, and use of e-cigarettes.^19,43-46 To minimize e-cigarettes’ appeal among tobacco-naïve young people, e-cigarette nicotine warnings may be further designed in a way to strengthen their noticeability and impact on perceived harm of e-cigarette use. Moreover, nicotine warnings for e-cigarette products marketed through social media platforms should be further monitored and enforced, given the low compliance with such warnings on social media.^47,48 These strategies may help offset the influence of appeal-promoting features on e-cigarette ads and minimize the overall appeal of e-cigarette ads and products among young people.

Our results show that noticing smoking cessation claims, which promote using e-cigarettes to quit smoking cigarettes or switching from cigarettes to e-cigarettes, may serve to minimize e-cigarette product appeal among non-tobacco-using young adults. This finding suggests that those smoker-targeted claims on e-cigarette ads may not stimulate participants’ intention to use e-cigarettes, potentially due to the low perceived relevance of such claims among non-tobacco-using young adults.⁴⁹ These results, together with our finding that noticing tobacco flavors does not promote e-cigarette product appeal, may inform the FDA’s marketing authorization on new e-cigarette products. Specifically, we speculate that e-cigarette marketing designed to target addicted adult cigarette smokers and promote original, tobacco-flavored e-cigarettes has the potential to encourage smokers’ switching to e-cigarettes but is less likely to increase e-cigarette trial among young people who are new to tobacco products. Research with rigorous scientific design (e.g., randomized controlled trials) is needed to test these research questions and inform how e-cigarette marketing (designed with certain features or not) may maximize desirable behavior change outcomes among both adult cigarette smokers and non-tobacco-using young people.

Furthermore, our findings related to the significant interactions between noticing various e-cigarette ad features signified that the potential protective effect of noticing certain e-cigarette ad features (e.g., nicotine warnings) may be reduced if participants also noticed certain appeal-promoting features. These findings may have implications for designing e-cigarette marketing and packaging to maximize warning labels’ effectiveness. Additionally, noticing certain features may only serve to increase e-cigarette product appeal when simultaneously noticing other appeal-promoting features (e.g., discounts and mint/fruit flavors). More research is needed to understand the combined and interactive effects of noticing various e-cigarette ad features.

This study has the following limitations. First, the e-cigarette ad stimuli used in the study did not include social media ads, which is one of the primary sources of e-cigarette marketing exposure among young adults.⁸ Social media ads may contain impactful marketing features (e.g., interactions with social media influencers) that are not captured by this study. Second, the e-cigarette ads used in this study were published in 2019 and 2020 and may not reflect newly emerged products (e.g., flavored disposable e-cigarettes) and marketing strategies (“tobacco-free nicotine” or “synthetic nicotine” claims) promoted by the e-cigarette industry.¹⁶ Third, this research did not take into account other visual characteristics of e-cigarette ads (e.g., high contrast, bright colors),^24,50 which may also affect product appeal. Lastly, this study only used self-reported noticing of ad features rather than objective measures of attention that can be assessed through eye-tracking and other neuropsychological-based tools. Research addressing the above limitations is greatly needed to further provide evidence on the impact of e-cigarette ad features among young adults.

Even after tightening governmental regulations on e-cigarette marketing that followed the surge of e-cigarette use from 2017–2019, our study indicates that non-tobacco-using young adults’ noticing of many e-cigarette advertising features marketed in 2019 and 2020 was still associated with increased e-cigarette product appeal. With flavored disposables and other emerging brands and types of e-cigarettes continuing to attract young people by employing appealing marketing tactics and features, more research is needed to inform the FDA’s regulatory decisions on e-cigarette marketing and new product authorization. The results from this study may inform the FDA’s evaluation and regulation of the marketing of e-cigarettes to reduce product appeal among non-tobacco-using young adults, a priority population for tobacco control.

CONCLUSION

This study found that among an online sample of non-tobacco-using young adults, attention to several e-cigarette ad features (e.g., models, price discounts, non-tobacco flavors) may increase e-cigarette product appeal, whereas attention to nicotine warnings and smoking cessation claims may reduce appeal among this group. Therefore, restricting appeal-promoting features while strengthening the effects of nicotine warnings and smoker-targeted claims may help reduce the overall product appeal among this population. The influence of new advertising features used by emerging e-cigarette brands and products (e.g., flavored disposables) needs to be further monitored and evaluated for its impact on e-cigarette-related perceptions and behavior among young people who are new to tobacco products.

What is already known on this topic:

• Exposure to e-cigarette advertising may affect perceived e-cigarette product appeal among young adults not currently using tobacco, a priority population for tobacco control.

What this study adds:

• This study identifies noticing e-cigarette advertising features associated with perceived e-cigarette product appeal among non-tobacco-using young adults.

• Noticing people, price discounts, menthol and mint/fruit flavors, positive experience claims, or product images was positively associated with reporting any e-cigarette product appeal.

• In contrast, noticing nicotine warnings or smoking cessation claims was negatively associated with reporting any e-cigarette product appeal.

How this study might affect research, practice or policy:

• Understanding the influence of specific e-cigarette advertising features among tobacco-naïve populations may be especially important for e-cigarette product policymaking.