Socioeconomic status and adolescent e-cigarette use: The mediating role of e-cigarette advertisement exposure

Prev Med. 2018 Jul:112:193-198. doi: 10.1016/j.ypmed.2018.04.019. Epub 2018 Apr 17.

Abstract

Among adolescents, low socioeconomic status (SES) is associated with greater exposure to tobacco cigarette advertising and cigarette use. However, associations among SES, e-cigarette advertising and e-cigarette use are not well understood. This study examined exposure to e-cigarette advertisements as a mediator of the relationship between SES and adolescent e-cigarette use. Adolescents (N = 3473; 51% Female) from 8 high schools in Connecticut completed an anonymous survey in Spring 2015. Mediation analysis was used to examine whether the total number of sources of recent e-cigarette advertising exposure (e.g., TV, radio, billboards, magazines, local stores [gas stations, convenience stores], vape shops, mall kiosks, tobacco shops, social media) mediated the association between SES (measured by the Family Affluence Scale) and past-month frequency of e-cigarette use. We clustered for school and controlled for other tobacco product use, age, sex, race/ethnicity and perceived social norms for e-cigarette use in the model. Our sample recently had seen advertisements via 2.1 (SD = 2.8) advertising channels. Mediation was supported (indirect effect: β = 0.01, SE = 0.00, 95% CI [0.001, 0.010], p = 0.02), such that higher SES was associated with greater recent advertising exposure, which, in turn, was associated with greater frequency of e-cigarette use. Our study suggests that regulations to reduce youth exposure to e-cigarette advertisement may be especially relevant to higher SES youth. Future research should examine these associations longitudinally and evaluate which types of advertisements target different SES groups.

Keywords: Adolescents; Advertising; E-cigarettes; SES.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Advertising*
  • Connecticut
  • Electronic Nicotine Delivery Systems*
  • Female
  • Humans
  • Male
  • Schools
  • Socioeconomic Factors*
  • Surveys and Questionnaires
  • Tobacco Use
  • Vaping*