The Effect of E-cigarette Commercials on Youth Smoking: A Prospective Study

: Objectives: In this study, we assessed whether commercials for electronic cigarettes (e-cigarettes) influence the use of e-cigarettes, cigarettes, and cigars among high-risk youth in southern California. Methods: We recruited students (N = 1060) from 29 alternative high schools into a prospective cohort study. We used multilevel Poisson regression models to examine whether exposure to e-cigarette commercials and perceptions of their appeal predicted increased use of e-cigarettes, cigarettes, and cigars one year later. We also tested the potential moderating effect of gender and ethnicity. Results: Models with and without covariates suggest that exposure to e-cigarette commercials is a statistically significant predictor of increased use of e-cigarettes. When gender was added to the models as a moderator, the relationships between commercial exposure and future use of e-cigarettes and cigars were found to be stronger among females. Unadjusted and adjusted models also indicated that students with favorable perceptions of e-cigarette commercials reported greater use of e-cigarettes, cigarettes, and cigars one year later. Conclusions: E-cigarette commercials may play an important role in persuading high-risk youth to use nicotine and tobacco products. Extending the Broadcast Advertising Ban of 1971 to include a broader range of products may be critical to preventing future generations from becoming addicted to nicotine.