The more often adolescents say they have seen adverts for e-cigarettes, the more often they use both e-cigarettes and smoke tobacco cigarettes, according to a study published in ERJ Open Research .
The study took place in Germany, where regulations around tobacco and e-cigarettes advertising are more permissive than in other parts of Europe. Elsewhere there are firm bans on advertising tobacco but certain types of adverts and promotions for e-cigarettes are permitted.
Researchers say their work provides evidence that children and teenagers should be protected from the potential harms of smoking and using e-cigarettes by a comprehensive ban on adverts and promotions.
Dr Julia Hansen, a Senior Researcher at the Institute for Therapy and Health Research (IFT-Nord), Kiel, Germany was a co-researcher on the study. She said: "The World Health Organization recommends a comprehensive ban on tobacco advertising, promotion and sponsorship in its Framework Convention on Tobacco Control. Despite this, in Germany, tobacco and e-cigarettes can still be advertised in shops, on billboards and in cinemas after 6pm. Elsewhere, although tobacco advertising may be banned, the regulations on advertising e-cigarettes are more variable. We wanted to investigate the impact that advertising might be having on young people."
The researchers asked 6,902 pupils from schools in six German states to fill in anonymous questionnaires. They were aged between 10 and 18 years, with an average age of 13. They were asked about their lifestyle, including diet, exercise, smoking and use of e-cigarettes. They were also asked about their socioeconomic status and school performance.
The pupils were presented with pictures of real e-cigarette adverts with brand names removed and asked how often they had seen each one.
Overall 39% of the pupils said they had seen the adverts. Those who said they had seen the adverts were 2.3 times more likely to say that they use e-cigarettes and 40% more likely to say that they smoke tobacco cigarettes. The results also suggest a correlation between seeing more adverts and using e-cigarettes and smoking tobacco cigarettes more often. Other factors such as age, sensation-seeking tendency, the type of school the teenagers attended and having a friend who smokes were also all linked to the likelihood of using e-cigarettes and smoking.
Dr Hansen said: "In this large study of adolescents we clearly see a pattern: those who say they have seen e-cigarette adverts are more likely to say they have used e-cigarettes and conventional cigarettes.
"This type of research cannot prove cause and effect, but it does suggest that e-cigarette advertising is reaching these vulnerable young people. At the same time, we know that the makers of e-cigarettes are offering kid-friendly flavours such as gummi bear, bubblegum and cherry.
"There is evidence that e-cigarettes are not harmless, and this study adds to existing evidence that seeing e-cigarette advertising and using e-cigarettes might also be leading adolescents on to smoking. There are concerns that e-cigarette use might act as a 'gateway' to cigarette smoking and may contribute to the development of a new generation of cigarette smokers. So youth should be protected from any kind of marketing actions."
Dr Hansen hopes to continue to study this large group of school pupils to see if there are any changes over time. She says this may help clarify the cause and effect between exposure to adverts, using e-cigarettes and smoking.
Professor Charlotta Pisinger is Chair of the European Respiratory Society's Tobacco Control Committee and was not involved in the research. She said: "Producers of e-cigarettes may argue that advertising is a legitimate way to inform adult users about their products. However, this study suggests that children and young people may be suffering 'collateral damage' as a result of lax regulation of e-cigarette advertising. Policy makers need to realise that advertising is reaching adolescents and that this may not only be promoting the use of e-cigarettes, but also the likelihood of smoking and the health problems that brings."