A new CDC study published in the journal Pediatrics found that exposure to e-cigarette advertising in forms including online, print media (in newspapers and magazines), and in the retail setting is associated with e-cigarette use among middle and high school students. The association also increases in magnitude as exposure increases – the greater the exposure to advertising, the greater the likelihood of e-cigarette use.

The study uses data from the National Youth Tobacco Survey. Middle and high school students were asked: “When you go to a store, supermarket, or gas station, how often do you see ads or promotions for electronic cigarettes or e-cigarettes?”

The retail setting was the common place youth were exposed to e-cigarette advertising, with 14.4 million middle and high school students reporting exposure to ads in stores.

High school students were who reported seeing e-cigarette ads “most of the time” or “always” were 91% more likely to be current e-cigarette users compared to those who were not as frequently exposed to in-store advertisements. Those who reported seeing ads in store “sometimes”  were 37% more likely to be current e-cigarette users than those who had not seen in-store ads. Middle school students who sometimes saw in-store ads for cigarettes were 78% more likely to be current e-cigarette users, and middle school students who reported seeing in-store ads most of the time or always were over twice as likely to be current e-cigarette users.

According to a CDC Vital Signs Report, in 2014, 70% of middle and high school students were exposed to e-cigarette advertisements, and over half of middle and high school students saw these advertisements in the retail setting.

Industry expenditures for e-cigarettes advertising, which remains unregulated at the federal level, increased from $6.4 million in 2011 to $115 million in 2014. Many of these advertisements use the same youth-appeal tactics Big Tobacco once used to advertise cigarettes, including celebrity spokespersons, glamour, sex, sports endorsements, sweet flavors, and cartoons.

The findings from this study highlight the need for comprehensive tobacco prevention and control strategies that reduce youth exposure to advertisement for e-cigarettes. Strategies to reduce youth exposure could include limiting sales or advertising near schools or restricting sale and advertising to adult-only facilities.

Learn more about e-cigarettes at the point of sale.