Electronic cigarette (e-cigarette) use among young adults represents a significant public health concern in the United States, with online marketing exposure—including advertisements, promotions, and sponsorships—potentially contributing to both initiation and continued vaping behaviors. Previous research examining this relationship has primarily relied on unaided recall measures, where participants are asked to spontaneously remember marketing exposure, an approach that may be compromised by self-report bias and memory retrieval limitations. To address these methodological concerns, this study aims to examine the association between recognition of e-cigarette marketing materials and positive attitudes and behaviors toward e-cigarette use among young adults by employing recognition-based measures that present participants with specific marketing stimuli to assess familiarity levels, thereby providing memory cues that can facilitate more accurate retrieval compared to traditional recall methods.
The study employed a sample of 1,500 young adults aged 18-24 living in California who were recruited through YouGov research panel agency to complete an online survey. Data collection involved presenting participants with 14 online e-cigarette marketing stimuli collected from Instagram, email communications, YouTube, and TikTok from 14 e-cigarette companies in randomized order to assess recognition, measuring positive e-cigarette-related attitudes (perceived benefits, appeal, purchase intentions) and susceptibility to use among never users, along with covariates including demographic characteristics, social media use, offline e-cigarette advertisement exposure, and past substance use. Statistical analysis utilized descriptive statistics to report prevalence of recognition of online e-cigarette marketing stimuli, logistic regression to examine relationships between stimuli recognition and positive e-cigarette-related attitudes and behaviors, and chi-square tests of independence to assess associations between e-cigarette use status and stimuli recognition, with all analyses weighted and adjusted for covariates.
The results indicated that 79.0% of participants recognized at least one marketing stimulus, with 78.1% of those under the legal tobacco-purchasing age (under 21 years old) also recognizing at least one stimulus, and participants recognized an average of 5 out of 14 stimuli (SD=4.2). Participants who recognized at least one stimulus, compared to those who recognized none, had significantly greater odds of reporting positive e-cigarette-related attitudes including appeal (AOR=2.26), benefits (AOR=1.79), and purchase intentions (AOR=1.66), as well as higher odds of lifetime e-cigarette use (AOR=1.77) and susceptibility to future use among never users (AOR=2.29). Additionally, a dose-response relationship was observed, with greater levels of stimulus recognition associated with increased odds of positive attitudes toward e-cigarette appeal (AOR=1.09), benefits (AOR=1.09), purchase intentions (AOR=1.09), lifetime use (AOR=1.08), and susceptibility to future use (AOR=1.13), and these associations remained consistent when analyses were restricted by stimulus type (image-based versus audiovisual stimuli).
Takeaway: Recognition of online e-cigarette marketing stimuli is significantly associated with positive attitudes toward e-cigarettes and increased susceptibility to use among young adults, with a clear association indicating that higher exposure levels correspond to stronger pro-vaping outcomes.