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Advertising and Attitudes Regarding E-Cigarettes and Tobacco Cigarettes

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Johns Hopkins University

Research & Writing Methods (480.600.82)

Professor Michael Bayer

December 16, 2021

Advertising and Attitudes Regarding E-Cigarettes and Tobacco Cigarettes

Cigarette smoking among American adults dropped 68% between 1965 and 2018. The primary factor that influenced people to quit or never start smoking cigarettes was that anti-smoking campaigns began educating people about the health concerns relating to smoking cigarettes. In 1970 the US government passed the Public Health Cigarette Smoking Act, which banned the advertising of cigarettes on television and radio (SLDP, n.d.).

Cigarette smoking among American youth dropped 68% between 1991 and 2017 (American Lung Association [ALA], n.d.). Hyland et al., (2006) found that state-run anti-smoking advertisements played a significant role in decreasing the number of youth smokers and increasing the number of those who quit among the adult population in 1999 and 2000. Cigarette smoking is on the decline in part because of government restrictions and mandates on cigarette companies and anti-smoking campaigns. It seems clear that the US has made an attitude shift about smoking cigarettes over the past few decades. Hyland et al., (2006) found that media campaigns and education about the danger of smoking played a fundamental role in this change.

While positive attitudes about tobacco cigarettes are on the decline, positive attitudes about e-cigarettes are rising. From 2011 to 2019, the use of e-cigarettes has “increased 1733 percent among high school students, from 1.5 percent to 27.5 percent. This was a 33 percent increase from the 2018 rate of 20.7 percent.” (ALA, n.d. para. 4). From 2002-2019 tobacco cigarette use has “​​decreased 74 percent among high school students, from 22.5 percent to 5.8 percent.” (ALA, n.d. para. 4). The CDC states that e-cigarettes are “unsafe for kids, teens, and young adults” and that “scientists are still learning about the long-term health effects of e-cigarettes” (Centers for Disease Control and Prevention [CDC], n.d. paras. 1-5). Alpert et al., (2019) finds that e-cigarette companies use similar advertising tactics that tobacco cigarette companies used. E-cigarette companies don’t have the same restrictions tobacco cigarette companies have, which allows them to advertise freely on social media and other platforms.

Literature Review

This research brief explores how e-cigarette companies have been able to reverse the attitude change American youth held about nicotine products. While e-cigs and cigarettes are not the same, there is a clear link between the health and social aspects. With the use of social media advertising, the government will have more difficulty placing bans and restrictions on e-cig companies. This brief will explore the relationship between attitudes held by the youth regarding e-cigs and how attitudes towards cigarettes were altered using campaigns in the past. Anti-smoking campaigns have been successful, but a successful anti-e-cig campaign won’t be the same. These findings intend to help an anti-e-cigarette campaign create an effective strategy to reduce e-cigarette use. It is critical for an anti-e-cigarette campaign to understand the studies in this brief so they can emulate effective aspects of anti-smoking campaigns of the past while modifying them to address a new product in a different time period.

Tobacco Cigarette Advertisement and Behavior

Research studies show that adolescents encounter cigarette advertisements at a high rate and that these advertisements and other marketing tools are effectively persuade them to smoke cigarettes. Krugman and King (2000), conducted content analysis on the most popular magazines among people 12-17 years old. The list of magazines was narrowed down to the 14 most popular that regularly have cigarette advertisements in them. The study found that if a cigarette advertisement was placed in one issue of each of the 14 most popular magazines, about 66% of the adolescent population would be exposed to a cigarette ad about twice from those magazines alone. Adolescents read other magazines, so an even higher percentage of them could be exposed to cigarette ads in magazines at a higher rate.

Altman et al. (1996), used telephone surveys to gather data from a random sample of 1047 adolescents to examine if participation in tobacco promotion campaigns is associated with susceptibility to tobacco use. The study defined experience with tobacco promotions as having awareness, knowledge of others owning items, and first-hand experience. The study found having experience with tobacco promotions is strongly associated with susceptibility to tobacco use. For example, the study showed that children who were aware of tobacco promotions were twice as likely as unaware children to use tobacco in the future. In addition, having first-hand experience or knowledge of others owning items was even more associated with future use.

Pierce et al. (1998), conducted a cohort study of 1762 adolescents in California who had never smoked. The subjects were surveyed in 1993 and again in 1996. The study showed that those who had favorite cigarette advertisements or were willing to use promotional items were far more likely to smoke in the future. The study estimated that, between 1993 and 1996, 34% of all first-time cigarette use in California could be attributed to promotional activities.

Masiero et al. (2021), conducted surveys of over 300 people to find associations between individual traits and the susceptibility to smoke cigarettes. The study found that those who consider themselves smokers first smoked a cigarette at around age 14. It also found that individuals who are more affected by social cues and positive reinforcement were associated with smoking cigarettes younger than others. In addition, individuals who want to explore, are easily frustrated or bored, and impulsive are more likely to smoke cigarettes than others.

E-cigarette Advertisement and Attitudes

Research shows that e-cigarettes have become more popular amongst adolescents and that advertisements and marketing play a role in shaping attitudes about the product. Cullen et al. (2019), conducted self-report surveys of 10,097 high school students and 8,837 middle school students. The study estimated that 27.5% of high school students reported current e-cigarette use, while an estimated 5.8% reported smoking cigarettes. The study also estimated that 10.5% of middle school students reported current e-cigarette use while an estimated 2.3% reported smoking cigarettes.

Chen et al. (2020), conducted five focus groups of non-e-cigarette users between 12 and 17 to explore their interpretation and engagement with e-cigarette advertising. Three themes emerged from the focus groups: “(1) Advertising motivates nonsmokers to use e-cigarettes”, “(2) There is a fascination with the technical and emotional appeals featured in commercials”, “(3) Searching for information about e-cigarettes involves little validation” (para. 21). One respondent said, “Ads show it looks cool, pictures are made to make smoking look cool”, another respondent said “They were highlighting features and technologies they had… So it was making it seem fancy—special vapor technology”, and another respondent said there are “Lots of videos (YouTube and Vines) of people doing smoke tricks and they look cool” (paras. 22- 23).

Alpert et al. (2019), performed a content analysis on the six most popular e-cigarette brands active on Twitter and found that 67% of the tweets emphasize their economic value, normalize their use by portraying them as cool, or use an affectionate/good natured approach. The tweets classified as cool include tactics like referencing celebrities who vape or mentioning current pop culture trends on Twitter. The affectionate/good natured approach includes tactics like promoting the company’s customer service or using inspiring quotes that are unrelated to vaping. Other common marketing strategies position e-cigarette users as health conscious, social, and/or adventurous.

Phua (2019), uses data from 1,016 participants who completed an online questionnaire to suggest that e-cigarette smokers have a more positive attitude towards quitting, perceive themselves as having more behavioral control over quitting, have higher intentions of quitting, and have a higher perceived self-efficacy towards quitting if they are not exposed to e-cigarette marketing on social networks. The data shows that exposure to advertisements, brand pages, and user-created groups alone correlates with a respondent’s attitude desire and perceived ability to quit smoking. The more social network marketing strategies a respondent is exposed to, the more likely they are to report having less desire and less ability to quit smoking.

Choi et al. (2012) conducted eleven focus groups containing 66 young adults and found that the majority had a positive attitude towards e-cigarettes. A common response was that e-cigarettes are preferred over cigarettes because they don’t smell and are easier to carry around. Respondents also mentioned that the design makes e-cigarettes seem high tech and made for the “new generation” (para. 12). Conversely, a theme amongst respondents with negative attitudes toward e-cigarettes was that these products were developed to deceive people and create a new market to make more money.

Anti-Smoking Campaigns

Studies show that anti-smoking campaigns can impact current smokers, but they are most effective in changing attitudes of those who haven’t taken up the habit. Colsten et al. (2021), conducted modified Poisson regression models to examine the association between anti-smoking media campaigns and cessation behavior of over 76,000 one-year smokers. The data was collected using five waves of surveys between 2001 and 2015. The study found that respondents with greater exposure to anti-smoking campaigns were no more likely to attempt to quit smoking but were more likely to report 30-day and 90-day cessation behavior compared to those with less exposure. The study also found that each wave of survey respondents was more likely to attempt quitting, 30-day cessation, and 90-cessation than the prior wave.

Pechmann et al. (2002), conducted a study in which “Ninth graders were randomly exposed to one of eight slice of life videotapes showing stimulus advertising (cigarette, anti-smoking, both, neither) and unfamiliar peers who either did or did not smoke cigarettes” (para. 1). They then used two-way ANOVAs and found that cigarette advertising primed positive smoker stereotypes. However, anti-smoking advertisements shown in conjunction with cigarette advertising induced negative smoker stereotypes and made the cigarette advertising ineffective. Subjects exposed to cigarette advertising and peers who smoke became more likely to have intentions of smoking.

Kranzler et al. (2019), used three data sets to figure out what makes a The Real Cost anti-smoking advertisement communicate a memorable message. They used ad recall surveys of people ages 13-17, measured ad reach and frequency, and performed fMRIs on subjects between 13-17 to track brain activity during ad exposure. The study found that more exposure to anti-smoking ads makes them more memorable, and anti-smoking ads that elicit social processing also makes them memorable. The study explains social processing as information that could “prompt adolescents to consider the social consequences to themselves or others” (para. 11). Activity of the regions of the brain associated with social processing was positively correlated with The Real Cost ads that had the highest message recall.

Conclusion

This research brief shows the similarities between how adolescents are persuaded to smoke and their attitudes about tobacco cigarettes and e-cigarettes. For both products there is a correlation between marketing engagement and future use. The social aspects of the product influence adolescents in both cases, and the qualitative findings in the brief will help a campaign address specific qualities that attract adolescents to e-cigs. Understanding that anti-smoking campaigns have a higher success rate at deterring people from ever picking up the habit, instead of causing someone to quit will help a campaign identify a target audience. Another finding that will help a campaign identify a target audience is that certain personality traits are more associated with certain smoking habits. Using information like social processing and the impact of peers could make a future campaign even more successful than the anti-smoking campaigns of the past.

References:

Alpert, J. M., Jaisle, A., & Chen, H. (2019). A content analysis of the promotional strategies employed by e-cigarette brands on Twitter. Health Marketing Quarterly, 36(4), 307–321. https://doi.org/10.1080/07359683.2019.1680121

Altman, David G., Douglas W. Levine, Remy Coeytaux, John Slade, and Robert Jaffe (1996), Tobacco promotion susceptibility to tobacco use among adolescents aged 12 through 17 years in a nationally representative sample. American Journal of Public Health, 86 (11), 1590-1593.

American Lung Association. (n.d.). Tobacco trends brief. Retrieved September 27, 2021, from https://www.lung.org/research/trends-in-lung-disease/tobacco-trends-brief/overall-tobacco-trends

Centers for Disease Control and Prevention. (2021, August 25). Quick facts on the risks of e-cigarettes for kids, teens, and young adults. Retrieved September 27, 2021, from https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html.

Chen, Y., Tilden, C., & Vernberg, D. K. (2020). Adolescents’ interpretations of e-cigarette advertising and their engagement with e-cigarette information: results from five focus groups. Psychology & Health, 35(2), 163–176. https://doi.org/10.1080/08870446.2019.1652752

Colston, D. C., Cho, B., Thrasher, J. F., Titus, A. R., Xie, Y., Emery, S., Elliott, M. R., & Fleischer, N. L. (2021). Anti-smoking media campaigns and disparities in smoking cessation in the United States, 2001-2015. American Journal of Health Promotion, 35(5), 658–668.

Cullen, K. A., Gentzke, A. S., Sawdey, M. D., Chang, J. T., Anic, G. M., Wang, T. W., Creamer, M. R., Jamal, A., Ambrose, B. K., & King, B. A. (2019). e-Cigarette use among youth in the United States, 2019. JAMA: Journal of the American Medical Association, 322(21), 2095–2103. https://doi.org/10.1001/jama.2019.18387)

Cummings, K., Higbee, C., Hyland, A., Szcyzypka, G., & Wakefield, M. (2006) Anti-tobacco television advertising and indicators of smoking cessation in adults: a cohort study. Health Education Research. 21(3), 348-354. https://doi.org/10.1093/her/cyl048

Choi, K., Fabian, L., Mottey, N., Corbett, A., & Forster, J. (2012). Young adults’ favorable perceptions of snus, dissolvable tobacco products, and electronic cigarettes: findings from a focus group study. American Journal of Public Health, 102(11), 2088–2093. https://doi.org/10.2105/AJPH.2011.300525

Kranzler, E. C., Schmälzle, R., Pei, R., Hornik, R. C., & Falk, E. B. (2019). Message-elicited brain response moderates the relationship between opportunities for exposure to anti-smoking messages and message recall. Journal of Communication, 69(6), 589–611. https://doi.org/10.1093/joc/jqz035 )

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Masiero, M., Cutica, I., Mazzocco, K., Zunino, A., Cropley, M., & Pravettoni, G. (2021). A comprehensive model of tobacco cigarette smoking in adolescence: The role of attachment style and personality. Journal of Psychology, 155(7), 589–605. https://doi.org/10.1080/00223980.2021.1934374

Pechmann, Cornelia, and Susan J. Knight (2002), An experimental investigation of the joint effects of advertising and peers on adolescents' beliefs and intentions about cigarette consumption. Journal of Consumer Research, 29 (1), 5-19.)

Phua, J. (2019). E-cigarette marketing on social networking sites: effects on attitudes, behavioral control, intention to quit, and self-efficacy. Journal of Advertising Research, 59(2), 242–254. https://doi.org/10.2501/JAR-2018-018 )

Pierce, John P., Won S. Choi, Elizabeth A. Gilpin, Arthur J. Farkas, and Charles C. Berry (1998), Tobacco industry promotion of cigarettes and adolescent smoking. Journal of the American Medical Association, 279 (7), 511-515

Schaffer Library of Drug Policy. (n.d.). History of tobacco regulation. Retrieved September 27, 2021, from https://www.druglibrary.org/Schaffer/LIBRARY/studies/nc/nc2b.htm.

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