Ads for candy-flavored e-cigarettes could encourage vaping among school children

E-cigarettes are now the most commonly consumed nicotine product amongst children in countries with strong tobacco control policies. In the USA, the 2014 National Youth Tobacco Survey found that e-cigarette use tripled from 2013 to 2014 amongst high schoolers, rising from 4.5% to over 13%, and amongst middle school students increasing from 1% to 4%. These figures are mirrored in England, where e-cigarette use has risen from 5% in 2013 to 8% in 2014 amongst 11-18 year olds.

As e-cigarette use, rises amongst children and adolescents, there are concerns that their use could lead to tobacco smoking, say researchers from the Behaviour and Health Research Unit at the University of Cambridge. The Behaviour and Health Research Unit (BHRU) is based in the Department of Public Health and Primary Care and funded by the UK Department of Health Policy Research Programme.

E-cigarettes are currently marketed in around 8,000 different flavours. Internal tobacco industry documents show that young people find tobacco products with candy-like flavours more appealing than those without. Candy- and liqueur-flavoured tobacco products were heavily marketed to young people from the 1970s until 2009, when regulations were imposed.

In a study funded by the Department of Health, researchers at Cambridge assigned 598 school children to one of three groups: one group was shown adverts for candy-like flavoured e-cigarettes; a second group adverts for non-flavoured e-cigarettes; and a third, control group, in which the children saw no adverts.

The school children were then asked questions to gauge issues such as the appeal of using e-cigarettes and tobacco smoking (did the children think e-cigarettes or tobacco were 'attractive', 'fun' or 'cool'?), the perceived harm of smoking, how much they liked the ads and how interested they might be in buying and trying e-cigarettes.

The children shown the ads for candy-flavoured e-cigarettes liked these ads more and expressed a greater interest in buying and trying e-cigarettes than their peers. However, showing the ads made no significant difference to the overall appeal of tobacco smoking or of using e-cigarettes -- in other words, how attractive, fun or cool they considered the activities.

"We're cautiously optimistic from our results that e-cigarette ads don't make tobacco smoking more attractive, but we're concerned that ads for e-cigarettes with flavours that might appeal to school children could encourage them to try the products," says Dr Milica Vasiljevic from the Department of Public Health and Primary Care at the University of Cambridge.

Currently across Europe and the USA, marketing and advertising of e-cigarettes is virtually unregulated. For example, in the UK the Committee on Advertising Practice has issued rules for the advertising of e-cigarettes. A key aspect of these rules is that e-cigarette adverts must not be likely to appeal to people under 18, and those who are non-smokers or non-nicotine users as well as not allowing the models in these adverts to appear younger than 25; however, the rules do not provide any explicit prohibitions regarding the advertising of candy-like flavours designed to appeal to children.

The results of the current study support the imminent changes in EU regulations surrounding the marketing of e-cigarettes, but raise questions about the need for further regulation regarding the content of products with high appeal to children. More research is needed to examine both the short- and long-term impact of e-cigarette advertising, as well as the link between e-cigarette use and tobacco smoking.