The effect of vaping cues in e-cigarette advertisements on normative perceptions about cigarettes among young adults who use cigarettes and e-cigarettes in Boston

Since the advent of e-cigarettes, there has been alarm that e-cigarettes may renormalize cigarettes, and block the path to smoking cessation. Some argue that the widespread use of e-cigarettes in public places will threaten hard-fought policies such as smoking bans that have aimed to make cigarettes less visible and less acceptable (Voigt, 2015). This is also a concern with e-cigarette advertising that features evaping cues; promotion of e-cigarettes that resemble cigarettes in their physical features and use behavior could increase perceptions that smoking cigarettes is prevalent and approved by other people (Voigt, 2015). For example, the similar hand-to-mouth motion and vapor that resembles cigarette smoke may lead to perceptions that cigarette smoking is still popular and approved among other people, which in turn could increase cigarette smoking. These concerns have also been expressed as a gateway hypothesis, where unregulated e-cigarette marketing that resembles long prohibited cigarette marketing could renormalize cigarettes and serve as a gateway to smoking cigarettes (Fairchild et al., 2014, Yang et al., 2018).

If the gateway hypothesis is valid, this poses a threat to people who have never used cigarettes and people who dual use. Specifically, for people who dual use, they may change to smoking only cigarettes or increase the number of cigarettes they smoke. Considering that vaping e-cigarettes poses a much smaller risk to health than smoking combustible cigarettes (McNeill et al., 2022), these transition behaviors are problematic. Increasing the number of cigarettes smoked or transitioning to smoking only, could manifest among people who mainly use e-cigarettes as an alternative to cigarettes due to restrictions (e.g., smoking bans) on cigarette smoking (Pokhrel et al., 2015). This could also happen among young people who attach values of coolness and independence to cigarette smoking (Ortved, 2022). The prevalence of dual use was 8.9 % among young adults in 2015 (Johnson et al., 2018), and young adults are targeted heavily by the e-cigarette industry (Duke et al., 2014).

Therefore, the objective of this study was to examine how exposure to vaping cues (hand-to-mouth motion and vapor) in e-cigarette advertisements affect normative perceptions about cigarettes among young adults who dual use. We conducted secondary analysis on a randomized experiment in which the primary objective was to examine whether vaping cues in e-cigarette ads influence urges and intentions to smoke cigarettes (Tan et al., 2019). This experiment exposed people who dual use to e-cigarette ads that had vaping cues or ads that removed these cues. Our outcomes of interest for this study were descriptive norms— how people estimate the prevalence of cigarette smoking— and injunctive norms—how people perceive others’ approval of cigarette smoking in general and personally. We focused on these outcomes since they are known to predict uptake of cigarettes among young people (East et al., 2021, Eisenberg and Forster, 2003, Epstein et al., 1999).

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