Vital Signs Report Telebriefing: E-Cigarette Advertising to Middle and High School Students

More than 18 million middle and high school students in the United States were exposed to e-cigarette advertisements from at least one source in 2014, according to a new Vital Signs report from the Centers for Disease Control and Prevention (CDC). The report, released on January 5, 2016, found that 68.9 percent of students in grades 6 through 12 reported seeing e-cigarette ads in retail stores, on the internet, on TV or in movies, or in newspapers and magazines.

The findings come from an analysis of the 2014 National Youth Tobacco Survey, a school-based survey of 22,007 middle and high school students. Exposure was measured across four sources: retail stores, internet, TV and movies and newspapers and magazines. Students who reported seeing ads “sometimes,” “most of the time,” or “always” were counted as exposed.

Among high school students, exposure was highest in retail stores at 56.3 percent, followed by the internet at 42.9 percent, TV and movies at 38.4 percent, and newspapers and magazines at 34.6 percent. For middle school students, retail stores led at 52.8 percent, then internet at 35.8 percent, TV and movies at 34.1 percent, and newspapers and magazines at 25.0 percent.

Dr. Tom Frieden, then-director of the CDC, emphasized the public health concern during a telebriefing on the report’s release. “Tobacco product advertising can persuade youths to start using tobacco,” he said. “This Vital Signs report contains important information on youth and their exposure to e-cigarette advertising.”

The report also broke down exposure by the number of sources. Among high school students, 21.1 percent reported exposure from one source, 17.0 percent from two sources, 14.5 percent from three sources, and 18.2 percent from all four sources. For middle school students, the figures were 23.4 percent from one source, 17.4 percent from two sources, 13.7 percent from three sources, and 11.9 percent from four sources.

Dr. Brian King, deputy director for research translation in CDC’s Office on Smoking and Health, noted that e-cigarette use had increased considerably among U.S. Youths since 2011. He reiterated that tobacco use among youths in any form, including e-cigarettes, is unsafe.

The CDC released the report as part of its Vital Signs series, which aims to highlight recent, important data on health threats and prevention opportunities. The agency stated that the findings underscore the need for comprehensive strategies to reduce youth exposure to tobacco advertising, including e-cigarettes.

At the time of the report, approximately 2.4 million middle and high school students were current (past 30-day) users of e-cigarettes in 2014, according to separate CDC data cited in related Vital Signs materials.

Context and Implications

Electronic cigarette advertising remains a concern for public health officials due to its potential influence on youth initiation. The 2014 data showed that a majority of U.S. Middle and high school students encountered e-cigarette promotions through multiple channels, with retail point-of-sale advertising being the most common source.

Since the release of this report, subsequent surveys have continued to monitor youth exposure to e-cigarette marketing and use patterns. The CDC has maintained that reducing youth access to and appeal of tobacco products, including through advertising restrictions, is a critical component of tobacco prevention efforts.