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E-cigarette adverts and children's perceptions of tobacco smoking harms: an experimental study and meta-analysis.

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St John Wallis, Amelia 
Codling, Saphsa 
Couturier, Dominique-Laurent 
Sutton, Stephen 


OBJECTIVES: Children exposed to electronic cigarette (e-cigarette) adverts may perceive occasional tobacco smoking as less harmful than children not exposed to e-cigarette adverts. Given the potential cross-cueing effects of e-cigarette adverts on tobacco smoking, there is an urgent need to establish whether the effect found in prior research is robust and replicable using a larger sample and a stronger control condition. DESIGN: A between-subjects experiment with one independent factor of two levels corresponding to the advertisements to which participants were exposed: glamorous adverts for e-cigarettes, or adverts for objects unrelated to smoking or vaping. PARTICIPANTS: English school children aged 11-16 (n=1449). OUTCOMES: Perceived harm of occasional smoking of one or two tobacco cigarettes was the primary outcome. Secondary outcomes included: perceived harm of regular tobacco smoking, susceptibility to tobacco smoking and perceived prevalence of tobacco smoking in young people. Perceptions of using e-cigarettes were gauged by adapting all the outcome measures used to assess perceptions of tobacco smoking. RESULTS: Tobacco smokers and e-cigarette users were excluded from analyses (final sample n=1057). Children exposed to glamorous e-cigarette adverts perceived the harms of occasional smoking of one or two tobacco cigarettes to be lower than those in the control group (Z=-2.13, p=0.033). An updated meta-analysis comprising three studies with 1935 children confirmed that exposure to different types of e-cigarette adverts (glamorous, healthful, flavoured, non-flavoured) lowers the perceived harm of occasional smoking of one or two tobacco cigarettes (Z=3.21, p=0.001). CONCLUSIONS: This study adds to existing evidence that exposure to e-cigarette adverts reduces children's perceptions of the harm of occasional tobacco smoking.



e-cigarette marketing, electronic cigarettes, preventive medicine, priority populations, public health, tobacco smoking, Adolescent, Advertising, Child, Electronic Nicotine Delivery Systems, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Prevalence, Schools, Tobacco Smoking, United Kingdom

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BMJ Open

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Department of Health (PRP number 107001)
National Institute for Health Research Policy Research Programme (Policy Research Unit in Behaviour and Health [PR-UN-0409-10109])