Recognition of Online E-cigarette Marketing and E-cigarette-Related Attitudes and Behaviors Among Young Adults.

Introduction: Past research examining the relationship between exposure to online e-cigarette marketing and e-cigarette-related attitudes and behaviors has relied on unaided recall measures that may suffer from self-report bias. To date, few studies have presented participants with e-cigarette marketing stimuli and assessed recognition. This study examined the associations between recognition of online e-cigarette marketing stimuli and e-cigarette-related attitudes and behaviors among young adults in California.

Aims and methods: A non-probability representative sample of young adults (ages 18-24; N = 1500) living in California completed an online survey assessing their recognition of online e-cigarette marketing stimuli, including image-based (ie, Instagram and email) and audiovisual (ie, YouTube and TikTok) promotions, and positive e-cigarette-related attitudes (eg, appeal of e-cigarettes) and behaviors (eg, e-cigarette use). Adjusted and weighted logistic regression analyses were used.

Results: A total of 79.0% (n = 1185) of young adults, including 78.1% (n = 310/397) of participants under 21 years old, recognized online e-cigarette marketing. Participants who reported recognition of stimuli, compared with those who did not, had greater odds of reporting appeal of e-cigarettes (AOR = 2.26, 95% CI = 1.65 to 3.09) and e-cigarette purchase intentions (AOR = 1.66, 95% CI = 1.13 to 2.43) among all participants, and susceptibility to use e-cigarettes among never users (AOR = 2.29, 95% CI = 1.59 to 3.29).

Conclusions: Young adults in California recognized audiovisual and image-based online e-cigarette marketing. Such recognition may lead to positive e-cigarette-related attitudes and behavioral intentions, especially among never users. Future research should examine the causal relationships between the associations found in this study. Findings may inform the development and evaluation of psychometrically valid measures of online e-cigarette marketing exposures.

Implications: Recognition of online e-cigarette marketing stimuli was associated with greater odds of reporting the appeal and benefits of e-cigarettes, purchase intentions, and lifetime e-cigarette use among all participants, and susceptibility to use e-cigarettes among never users. These findings may motivate the development and evaluation of psychometrically valid measures of online e-cigarette marketing exposures.