Socioeconomic status and adolescent e-cigarette use: The mediating role of e-cigarette advertisement exposure

• Published in: Preventive medicine 2018-07, Vol.112, p.193-198
• Main Authors: Simon, Patricia, Camenga, Deepa R., Morean, Meghan E., Kong, Grace, Bold, Krysten W., Cavallo, Dana A., Krishnan-Sarin, Suchitra
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescents; Advertising; Connecticut; E-cigarettes; Electronic Nicotine Delivery Systems; Female; Humans; Male; Schools; SES; Socioeconomic Factors; Surveys and Questionnaires; Tobacco Use; Vaping
• ISSN: 0091-7435; 1096-0260
• DOI: 10.1016/j.ypmed.2018.04.019

Among adolescents, low socioeconomic status (SES) is associated with greater exposure to tobacco cigarette advertising and cigarette use. However, associations among SES, e-cigarette advertising and e-cigarette use are not well understood. This study examined exposure to e-cigarette advertisements as a mediator of the relationship between SES and adolescent e-cigarette use. Adolescents (N = 3473; 51% Female) from 8 high schools in Connecticut completed an anonymous survey in Spring 2015. Mediation analysis was used to examine whether the total number of sources of recent e-cigarette advertising exposure (e.g., TV, radio, billboards, magazines, local stores [gas stations, convenience stores], vape shops, mall kiosks, tobacco shops, social media) mediated the association between SES (measured by the Family Affluence Scale) and past-month frequency of e-cigarette use. We clustered for school and controlled for other tobacco product use, age, sex, race/ethnicity and perceived social norms for e-cigarette use in the model. Our sample recently had seen advertisements via 2.1 (SD = 2.8) advertising channels. Mediation was supported (indirect effect: β = 0.01, SE = 0.00, 95% CI [0.001, 0.010], p = 0.02), such that higher SES was associated with greater recent advertising exposure, which, in turn, was associated with greater frequency of e-cigarette use. Our study suggests that regulations to reduce youth exposure to e-cigarette advertisement may be especially relevant to higher SES youth. Future research should examine these associations longitudinally and evaluate which types of advertisements target different SES groups. •Mediators of the association between SES and e-cigarette use are yet unknown.•We examined data from 3473 high school students.•Higher SES is associated with greater exposure to e-cigarette advertising.•Higher advertising exposure is associated with greater e-cigarette use.•Advertising exposure mediates the association between SES and e-cigarette use.