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. 2020 Jul;146(1):e20194020.
doi: 10.1542/peds.2019-4020.

E-cigarette Marketing Regulations and Youth Vaping: Cross-Sectional Surveys, 2017-2019

David Hammond  1 , Jessica L Reid  2 , Robin Burkhalter  2 , Vicki L Rynard  2
Affiliations

E-cigarette Marketing Regulations and Youth Vaping: Cross-Sectional Surveys, 2017-2019

David Hammond et al. Pediatrics. 2020 Jul.

Abstract

Background: Increased electronic cigarette (e-cigarette) use among young people is often attributed to industry marketing practices; however, the effectiveness of regulations that limit e-cigarette advertising and promotions has yet to be examined. New federal legislation that liberalized the Canadian e-cigarette market in May 2018, along with differences in provincial regulations, provides an opportunity to examine the impact of regulatory restrictions on e-cigarette marketing.

Methods: Repeat cross-sectional surveys of 12 004 16- to 19-year-olds in Canada, completed online in 2017, 2018, and 2019. Logistic regression models were used to examine differences over time in exposure to e-cigarette marketing and e-cigarette use, including between provinces with differing strengths of marketing restrictions.

Results: The percentage of youth surveyed who reported noticing e-cigarette promotions often or very often approximately doubled between 2017 and 2019 (13.6% vs 26.0%; adjusted odds ratio [AOR] = 2.24, 95% confidence interval [CI] = 1.97-2.56). Overall exposure to marketing was generally more prevalent in provinces with fewer regulatory restrictions. Respondents who reported noticing marketing often or very often were more likely to report vaping in the past 30 days (AOR = 1.41, 95% CI = 1.23-1.62), past week (AOR = 1.44, 95% CI = 1.22-1.70), and ≥20 days in the past month (AOR = 1.42, 95% CI = 1.11-1.81, P = .005). Provinces with low restrictions on marketing had higher prevalence of vaping in the past 30 days (AOR = 1.50, 95% CI = 1.25-1.80, P < .001), and in the past week (AOR = 1.65, 95% CI = 1.33-2.05, P < .001).

Conclusions: Exposure to marketing and the prevalence of vaping increased among Canadian youth after the liberalization of the e-cigarette market in 2018. Comprehensive provincial restrictions on e-cigarette marketing were associated with lower levels of exposure to marketing and lower prevalence of e-cigarette use.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Hammond has served as a paid expert witness in legal challenges against tobacco companies; the other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Noticing e-cigarette marketing often or very often, by strength of provincial marketing regulations, 2017 to 2019 (n = 12 004). Low restrictions were in Alberta and Saskatchewan; low-moderate restrictions were in Ontario; moderate restrictions were in New Brunswick and Newfoundland and Labrador; moderate-high restrictions were in British Columbia; and high restrictions were in Quebec, Manitoba, Nova Scotia, and Prince Edward Island.
FIGURE 2
FIGURE 2
Noticing e-cigarette advertisements and promotions permitted and prohibited in specific channels by province, 2017 to 2019. A, Noticed ads inside stores and shops. B, Noticed ads outside stores and shops. C, Noticed ads on television or radio. D, Noticed ads on billboards or posters. E, Noticed ads in newspapers or magazines.
FIGURE 3
FIGURE 3
Prevalence of vaping by strength of provincial marketing restrictions, 2017 to 2019. A, Prevalence of vaping in the past 30 days. B, Prevalence of vaping in the past week. C, Prevalence of vaping ≥20 days in the past month. aHigh variability, interpret with caution.
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