Each month, an OSP staff member interviews an American University faculty member to highlight their contributions in providing cutting-edge research that serves to create and advance knowledge, and enrich the resources of our educational community. This month, we are featuring Cristel Russell, PhD, Associate Professor, Department of Marketing, Kogod School of Business.
You received funding from the Institut National du Cancer to conduct research on “E-cigarette Marketing and Influences on Youth.” Could you give us an overview of this project? Have there been any surprising discoveries?
The project focuses first on reviewing existing policies, which are ever evolving. Regulating e-cigarettes has proven a difficult undertaking and the international community has taken a varied response, ranging from outright banning e-cigs to enacting comprehensive e-cig-specific legislation. Intermediary approaches include amending existing tobacco legislation to include e-cigs, and differentiating regulation based on whether a device uses nicotine. One of the difficulties of regulating e-cigarettes is that they have been positioned as a beneficial alternative to traditional tobacco consumption and a smoking cessation tool for adult smokers, although findings remain inconclusive. Nonetheless, international anti-smoking organizations, such as the Action on Smoking and Health (2016), actively advocate for e-cig usage as a less harmful alternative to smoking and have even bemoaned the fact that healthcare policymakers are not better integrating e-cigs into sanctioned cessation efforts.
The greater policy concern is youth experimentation with e-cigs, which is the focus of this research project. This concern is rooted in the belief that e-cigs might serve as a catalyst for a new generation of nicotine addicts and ultimately lead to an increase in traditional tobacco use by renormalizing smoking behavior, which has steadily been curtailed in many countries resultant of multiple prevention effort.
What has been the impact on traditional cigarette marketing since the emergence of e-cigarettes?
We do not yet know if e-cigarette trial leads more teens to eventually pick up tobacco in the traditional form. This study will help us answer this question. We are interested in whether the same symbols are used by advertisers to communicate about e-cigs as with cigarettes.
What are some of the methods that the E-cigarette industry uses to engage with youth?
Although the e-cig industry asserts that its focus is on adult consumer, the product’s 400+ flavors, the ease of concealment, and general access all appeal to youth. As e-cigs are still in the early stages of new product diffusion, advertising efforts remain aggressive and designed to generate positive product images and beliefs. In the US, e-cig advertising expenditures increased from US$6.4 million in 2011 to US$115 million in 2014 while e-cig use concurrently increased from 0.6% to 3.9% for those aged 11-13 and from 1.5% to 13.4% for those aged 14-18 (CDC 2016).Youth encounter e-cig across a range of media. A large US youth study reported high-levels of exposure to e-cig advertising across multiple sources; among age groups of 11-13 and 14-18, exposure was: retail stores (52.8%/56.3%, 14.4 million combined), Internet (35.8%/42.9%, 10.5 million combined), television/movies (34.1%/38.4%, 9.6 million combined), and newspapers/magazines (25.0%/34.6%, 8 million combined). Youth exposures are likely to increase if unchecked; for instance, a US-based study found that youth exposure to e-cig television advertising alone increased by 256% between 2011 and 2013. E-cig advertisements promote traditional positive usage behaviors and associated outcomes (e.g., looking cool by blowing vapor from one’s mouth) and negate regulatory barriers established to curtail smoking behavior. Images often have purposeful youth appeal (e.g., portraying young people having fun while using the product) and in youth-oriented media. This is what the first phase of this project in France is documenting: what are the images and themes used by e-cig companies and how are those interpreted by youth?
In December 2016, the U.S. Surgeon General stated that the use of e-cigarettes among youth is a major public health concern. In your opinion, what can be done to protect the youth from this industry.
Market surveillance is especially prudent at a time when the e-cig industry is increasing efforts to lobby government bodies at all levels; for example, between 2011-16, US$63 million was contributed to politician campaigns and ballot efforts. Surveillance of e-cigarette marketing, performing content analyses of the messages and media used (like we are doing here), and conducting studies to assess the link between exposure to e-cigarette marketing and the use of e-cigarette products (again like this research aims to do), particularly among youth and young adults, will facilitate the development of an evidence base of the type that informed prior. As the body of research evidence grows, specific e-cig strategies may be targeted more specifically for active legislation.
What are your ideas for further research?
In parallel public health advocates may want to promote media literacy campaigns that have proven a useful tool to reduce the prevalence of tobacco use among school-aged youth. But these campaigns must be specific and targeted, and must engage multiple partners, from schools, families, and the contribution of media institutions. As I head on sabbatical in France, my goal is to develop one such media literacy intervention to help adolescents discern what are ads and what they are designed to do and to help them fight against these influences.