18B.2 Advertising and promotion

Last updated:  April 2020

Suggested citation: Greenhalgh, EM, & Scollo, MM. InDepth 18B: Electronic cigarettes (e-cigarettes). In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2020. Available from:  http://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/indepth-18b-e-cigarettes

 

The increasing popularity of e-cigarettes has been largely attributed to aggressive promotion over the Internet.1 Even prior to major promotion by tobacco companies, one study found that a large proportion of people in the US were aware of the existence of e-cigarettes, naming television, word of mouth, and the Internet as their top three sources of information.2 Between 2009 and 2010, awareness doubled from 16.4% to 32.2%,3 and has continued to increase over time.4 E-cigarettes are now widely promoted using a range of channels, including online through banner and video adverts and social media (primarily YouTube and Twitter), print media, television, and in shops.5 Globally there were 75 news stories per day on the topic of e-cigarettes in 2018, compared with eight stories per day in 2013.6

E-cigarette promotional spending has rapidly increased over time.7 Revenue spent on advertising of e-cigarettes in the US is estimated to have trebled between 2011 and 2012 (from $US6.4 million to $18.3 million) and reached $88.1 million in 2014.8 Almost 40% of this expenditure was attributed to Altria’s promotion of Markten.9  Vuse (R. J. Reynolds) spending on television marketing alone in 2015 and 2016 exceeded US$16 million. On the other hand, marketing expenditure for Juul between 2015 and 2017 was relatively moderate, with its enormous growth attributed to a range of innovative and engaging campaigns on social media.10

18B.2.1 Content of e-cigarette advertisements

The advertising of e-cigarettes is frequently aimed at smokers, often comparing electronic and tobacco cigarettes. E-cigarettes are frequently marketed as healthier, cheaper, more socially acceptable, and more amenable to use with indoor smoking restrictions in comparison with tobacco cigarettes. Despite limited evidence on their efficacy for this purpose, they are also frequently marketed as a useful cessation aid.11 Mass media campaigns sponsored by Public Health England early in 2019 have specifically referred to e-cigarettes as a useful tool.12

An analysis of print advertisements in the US found that the advertisements typically implied use for harm reduction, or as a partial alternative to cigarettes (dual use) and often incorporated the theme of individuality, sociability, and sexuality. Particular demographics were targeted depending on the publication; for example, a blu ad in Rolling Stone magazine showed a shirtless man lying in bed next to an overweight, semi-naked woman with the words ‘no regrets’ boldly highlighted. In contrast, a blu ad in Us Weekly showed a stylish, attractive woman with the text: ‘Freedom never goes out of fashion… blu produces no tobacco smoke and no ash, only vapor, making it the ultimate accessory….Step out in style with blu.’13 

Similarly, an analysis of e-cigarette retail websites found that almost all made explicit or implicit health-related claims—including many that featured doctors—and the majority had a smoking cessation-related claim.14 Such sites generally lack adequate information regarding nicotine and addiction, or potential health risks of using the products.15 E-cigarettes are generally portrayed as cleaner, cheaper, and useful for circumventing smokefree policies. Celebrity endorsements, cartoons, flavours, and implications of increased social status may be particularly appealing to young people,14, 16-19 and such forms of advertising have been likened to traditional cigarette advertising.16, 20-22

As with tobacco cigarettes (see Section 11.11), social media serves as a low-cost way for e-cigarette companies to target current and potential users. A review of e-cigarette messaging on social media found that discussions were mostly occurring among the general public and retailers and manufacturers, rather than public health experts. The products were being promoted as safer, as a useful cessation aid, and for use where smoking is prohibited. Novel flavouring and the public performance of vaping were also common themes.23 An analysis of the promotional strategies employed on Twitter found that most Tweets emphasised the  relative affordability of e-cigarettes, and portrayed the products as “cool”.24 Researchers have also highlighted a proliferation of JUUL related content on Instagram, which connects with youth culture and lifestyle appeals using memes, hashtags, tag lines, and promotional friend-tagging.25 A study of JUUL’s Twitter followers found most (81%) were under 21 years of age.26 In the US, an investigation into Juul Labs Inc.’s role in the ‘youth nicotine addiction epidemic’ found that JUUL recruited thousands of online ‘influencers’ to market to teens.27, 28 While exposure to e-cigarette marketing at the point of sale tends to reflect country-specific policies (i.e., is lower in countries that have stricter policies), exposure to e-cigarette advertisements on websites or social media does not appear to follow country-specific policies, highlighting the difficulty in regulating online marketing.29

18B.2.2 Effects of e-cigarette advertising on adults

Several experimental studies have shown an association between exposure to e-cigarette advertising and intention or desire to use an e-cigarette among young adults in the general population.30, 31 Among smokers, e-cigarette advertising appears to increase desire both to use e-cigarettes and tobacco cigarettes,32-34 and among ex-smokers, exposure to e-cigarette adverts can increase desire to smoke and weaken confidence in abstaining.35

A study of smokers’ reactions to e-cigarette advertising has found that their interest in trying e-cigarettes is highest after viewing ads with messages about differences between regular and electronic cigarettes, such as claims about e-cigarettes’ lower cost, greater ‘healthfulness’ and utility for smoking cessation, as well as when they see advertisements showing someone actually using the product.36

18B.2.3 Effects of e-cigarette advertising on children

Between 2011 and 2013, exposure to television advertisements for e-cigarettes increased among US youth (aged 12-17) by 256%, and in young adults (aged 18-24) by 321%.37  A growing body of experimental studies have examined the effects of e-cigarette advertising on the appeal of e-cigarettes and tobacco cigarettes among children. As with adults, children exposed to e-cigarette adverts report more positive attitudes toward and greater curiosity about and intention to use the products.38-42 Correlational43-47 and longitudinal48-51 studies have also found an association between e-cigarette marketing exposure and greater use of e-cigarettes. Outside of Australia (where such displays are banned), exposure to tobacco marketing in retail outlets may also increase adolescents’ willingness to use e-cigarettes.52 In 2016 in the US, exposure to e-cigarette advertising was highest for retail stores (68.0%), followed by the internet (40.6%), television (37.7%), and newspapers and magazines.53

While cigarette websites generally require age-verified accounts for entry, a recent analysis found that the majority of e-cigarette websites required accounts only for making purchases.54 Adverts promote perceptions among children that e-cigarettes are fun, cool, healthier/safer than tobacco cigarettes, and can be used to circumvent smokefree policies.38, 39 Flavoured e-cigarette adverts appear to elicit greater appeal and interest in buying and trying e-cigarettes than ads for non-flavoured products.55 Greater social media use—where e-cigarette advertising is often youth focused—is also associated with a greater risk for e-cigarette use among adolescents.42

Some studies have not found evidence that exposure to e-cigarette adverts increases the appeal of tobacco smoking among children,55, 56 although such exposure may reduce the perceived harms of occasional tobacco smoking.56, 57 A longitudinal study in the US found that receptivity to e-cigarette marketing was associated with later conventional cigarette smoking,58 while research in Germany found that exposure to e-cigarette advertisements may increase the likelihood of initial use of e-cigarettes, cigarettes, and hookahs.59 Another US study found that e-cigarette advertising in addition to existing traditional tobacco advertising appears to be associated with the use of tobacco and nicotine products among adolescents.60 More frequent exposure to e-cigarette commercials may be associated with increased use of e-cigarettes and cigarettes among young people.51

18B.2.4 Retailing of e-cigarettes

Like conventional cigarettes, the majority of in-person e-cigarette retailers are supermarkets, convenience stores and service stations. However, the number of specialist e-cigarette shops (’vape shops’) has grown in the US and UK, and in France, Belgium, and Switzerland vape shops serve as the main retail channel. Following the tobacco retail display ban in the UK, there were reports that some shop owners replaced closed tobacco cabinets with vaping stands.61 In New Zealand, a 2017 analysis found that among e-cigarette retailers, products were visible at point of sale in almost all (89%) stores, including 15% with self-service displays and 15% with displays adjacent to children's products. Advertising was present in 31% of the outlets.62

In Australia, there are a smaller number of speciality vape shops; however, such stores are prohibited from selling nicotine products (see Section 18B.8). Some states have also included e-cigarettes in their tobacco retail licencing schemes, or introduced separate restrictions regarding the sale of e-cigarettes (see Table 2, Section 11.9). An evaluation of an e-cigarette retail licensing policy in Pennsylvania found that it was associated with a reduction in e-cigarette use among adolescents.63

18B.2.5 Packaging of e-cigarettes

Along with advertising that appeals to children, e-cigarette manufacturers have been criticised for creating child-friendly packaging for e-cigarette products and liquids. In 2018, the FDA issued warnings to companies that had created nicotine-containing e-liquids that resembled juice boxes, lollies, and cookies. Many products also had cartoon characters on their labelling. Along with increasing the appeal of these products for use among adolescents, the FDA notes that many could be mistaken for food or beverage products by younger children, leading to increased poisonings.64

Although nicotine-containing e-cigarette products are banned in Australia, there have been similar reports of non-nicotine e-liquids being sold in packaging that includes cartoon imagery and fruit and lolly flavours. Experts have called for stricter regulations on the marketing and sale of e-cigarette products, particularly online.65

Figure 18B.2.1 E-cigarette liquids purchased in NSW, Australia
Source: NSW Health

 

Relevant news and research

For recent news items and research on this topic, click  here. ( Last updated October 2020)

 

References 

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