Patterns in Tobacco, E-Cigarette, and Cannabis Advertising Exposure Among California Adolescents and Associations With Future Use Expectations

Abstract

Background

Exposure to tobacco, e-cigarette, or cannabis marketing is associated with adolescent use. Few studies have examined advertising exposure prevalence and patterns across these products concurrently.

Methods

This study assessed past 30-day recalled exposure to promotional messages about tobacco, e-cigarettes (“vapes” on the survey), and cannabis (“marijuana”) from various sources among California adolescents (ages 12–17) in the 2022 Teens, Nicotine, and Tobacco Online Survey (N = 2530). Principal components analysis (PCA) was conducted to examine the underlying structure and patterns in advertising exposure sources. Multivariable logistic regression was used to evaluate associations between any advertising exposure and future use expectations (a susceptibility measure) in one year and at age 25 among current never-users.

Results

Overall, 65.9% of participants recently noticed at least one tobacco (52.5%), vape (51.5%), or marijuana (45.6%) advertisement. Gas stations or convenience stores were the most common source for tobacco or vape ads; billboards were for marijuana ads. In PCA, advertising exposure patterns correlated with advertising source, not the type of product. Exposures from tobacco-specific sources and nearer point of sale were associated with current use, older age, LGBTQ + identity, and sensation seeking. Among never-users, advertising exposure was associated with one-year and age-25 use expectations for cigarettes (one-year expectations adjusted odds ratio: 1.7; 95% CI: 1.1, 2.5), vapes (2.3; 1.5, 3.5), and marijuana (2.1; 1.5, 3.0).

Conclusion

California adolescents’ exposure to tobacco, e-cigarette, and cannabis marketing is common, follows similar patterns, and is associated with use susceptibility. Comprehensive restrictions on marketing accessible to adolescents could help prevent youth use.

Keywords:

• Tobacco marketing
• adolescent health
• cannabis
• electronic cigarettes
• tobacco control

Acknowledgements

Thank you to Monica Wilkinson of the California Department of Public Health for technical assistance. Thank you to Kristin Hoeft and Claudia Guerra of the University of California San Francisco for their contributions to survey item testing.

Disclosure statement

The authors report no conflicts of interest to declare.

Additional information

Funding

This work was supported by the California Department of Public Health (contract number: CDPH-20-10026) and the National Institutes of Health (grant number: U54 HL147127). The findings and conclusions in this article are those of the author(s) and do not necessarily represent the views or opinions of the National Institutes of Health, the California Department of Public Health, or the California Health and Human Services Agency.