Full length articleE-cigarette advertising exposure and implicit attitudes among young adult non-smokers
Introduction
E-cigarette use prevalence is increasing rapidly among youth and young adults. According to a recent Monitoring the Future (MTF) survey (Johnston et al., 2015), past-30-day e-cigarette use prevalence among high school students has surpassed the prevalence of past-30-day cigarette use. Among U.S. adults, young adults (18–24 year olds) show the highest prevalence of e-cigarette use (21%; Schoenborn and Gindi, 2015). Although e-cigarette use prevalence is concentrated mostly among current or former regular cigarette smokers, there are concerns that e-cigarette use is on the rise even among those youth and young adults who do not smoke tobacco (Wills et al., 2015; Primack et al., 2015). Among U.S. young adults, approximately 10% of never cigarette smokers report having tried an e-cigarette (Schoenborn and Gindi, 2015).
The role of tobacco product marketing in promoting tobacco use initiation is well-documented (National Cancer Institute, 2008). E-cigarette marketing appears to be expanding aggressively. For example, between 2011 and 2013, young adults’ exposure to television e-cigarette ads increased by 321% (Duke et al., 2014). The e-cigarette marketing expenditures for 2013 represented more than twice the expenditures for 2012 (Kornfield et al., 2015). At present, e-cigarette marketing is not regulated. This is of concern because e-cigarette marketing is thought to be using tactics similar to those used by the tobacco industry to market cigarettes in the past (Grana and Ling, 2014). To date, limited empirical evidence exists as to whether e-cigarette advertising persuades young people to believe that e-cigarettes are less harmful than cigarettes or that e-cigarette use may enhance their social lives or self-image.
In consumer psychology and social cognition research, the effects of spontaneous or automatic cognitive processes—presumed to function outside awareness or consciousness—on consumer decision-making are well recognized (Maison et al., 2001, Brunel et al., 2003). However, such processes have not received sufficient attention in research on tobacco product marketing. Past tobacco research has almost exclusively assessed marketing effects using self-report measures which capture variables that are “explicit” or within the reaches of awareness. Although valid and useful, such explicit processes may be just one of the two main ways that the effects of tobacco product marketing are mediated. Automatic processes are measured by using implicit instruments, which assess the implicit attitude or cognition construct indirectly by having participants perform certain tasks or tests (e.g., word association, sentence completion; De Houwer, 2006).
Strategic use of implicit measures in research may help demonstrate how tobacco product marketing shapes automatic attitudes towards tobacco products among potential consumers, including current non-users of tobacco products. Such evidence may be especially important in regulating new tobacco products such as e-cigarettes which are currently unregulated. E-cigarette marketing appears to be using implicit, if not overt, tactics to attract young people or promote e-cigarettes as a safer alternative to cigarettes (Grana and Ling, 2014). Such implicit tactics may encourage spontaneous association of e-cigarettes with reduced risk attributes or enhanced social life or self-image.
Two implicit attitude measures commonly used in social attitudes research are the Implicit Association Test (IAT; (Greenwald et al., 1998) and the Affect Misattribution Procedure (AMP; Payne et al., 2005). For the current investigation the IAT was specifically adapted to assess the automatic preference for e-cigarettes as a safer or healthier alternative to cigarettes. The IAT is a categorization task which functions on the assumption that individuals are faster at categorizing those concepts together that are compatible to them spontaneously than those that are incompatible. The AMP was adapted to assess spontaneous affective reaction (e.g., pleasant vs. unpleasant) to e-cigarette and cigarette stimuli. The task works under the assumption that individuals are likely to subliminally misattribute the affect induced by a priming stimulus (e.g., image of an e-cigarette or cigarette) to another stimulus that is ambiguous in terms of affect (e.g., irregular shapes with no meaning).
This experimental study examined the subliminal impact of real-world print e-cigarette ads on currently non-smoking young adults. Four main hypotheses were tested: (1) participants exposed to Health ads (i.e., ads containing implicit or explicit reduced-harm or health-benefit messages) would score higher on the IAT than those exposed to Control or Social ads (i.e., ads containing implicit or explicit messages promoting e-cigarettes as a means to enhance one’s social life or self-image); (2) for e-cigarette cues, participants in the Social condition would score higher on the AMP than those in the Health or the Control condition; (3) implicit attitude measures would be moderately correlated with explicit measures of attitudes, including openness to use e-cigarettes, indicating that they assess distinct yet related constructs; and (4) participants in the experimental conditions would show increased openness to using e-cigarettes in the future relative to those in the control condition.
The second hypothesis was based on the assumption that young adults would find Social ads more attractive than the Health ads because Social ads, by definition, would include images or words signifying pleasant lifestyle that are particularly attractive to young adults. Hypotheses concerning the effects of the experiment on explicit attitudes were not tested at the current phase of the study because such effects were assumed be very small, as the current experiment involved a relatively indirect exposure to e-cigarette ads and the sample included young adults who were non-smokers.
Section snippets
Participant recruitment
Participants (N = 187) were recruited on college campuses in the Hawaiian island of Oahu. The study was advertised at one 4-year and two 2-year colleges through the use of flyers, classroom presentations, and e-mail listservs. Interested students telephoned a research project staff who conducted the initial screening for participation eligibility over the telephone. Participants were invited to the study laboratory if they met the following inclusion criteria: they (1) were 18–29 years in age;
Participants
Table 1 describes the characteristics of the participants. The mean age of the participants was 21.9 (SD = 4.1) and participants were ethnically diverse. None of the participants had ever used an e-cigarette and all participants were current non-smokers of cigarettes. Approximately 40% of the participants had experimented smoking cigarettes in the past, however. These experimenters had smoked fewer than 100 cigarettes in their lifetime and none in the last year. Participants did not differ
Discussion
This is the first study to show that exposure to e-cigarette advertising induces favorable automatic or spontaneous attitudes towards e-cigarettes among young adults who are current non-smokers of cigarettes and who have never used an e-cigarette. Given that young adults are heavily exposed to e-cigarette advertising, not only on TV but also at point-of-sale and in the print media, this is an important finding. The current data suggest that e-cigarette advertising with themes of social
Conclusions
Implicit attitude measures such as the IAT and AMP may be a valid way to assess spontaneous or automatic attitudes towards e-cigarettes. Exposure to e-cigarette ads may impact young adults, implicitly if not explicitly, to form automatic attitudes towards e-cigarettes as safer, healthier alternatives to tobacco cigarettes. Exposure to e-cigarette ads with social enhancement messages may promote openness to use e-cigarette among young adult non-smokers who have never used an e-cigarette. Lastly,
Role of funding source
This research was supported by a research grant [3P30CA71789-16S2 (Project 2)] from Food & Drug Administration/National Cancer Institute.
Contributors
PP designed the study, conducted the data analysis, and led the manuscript preparation. PF and TAH contributed to the development and implementation of the study protocol and helped prepare the manuscript. QC assisted in the development of the experimental content and procedure. LK and NM assisted with participant recruitment, data collection, and literature review. JBU reviewed the manuscript helped interpret the data. All authors approved the final manuscript.
Conflict of interest
No conflict declared.
Acknowledgements
The authors would like to thank Dr. Keith Payne, Professor of Psychology and Neuroscience, University of North Carolina at Chapel Hill, for help with the development of the Affect Misattribution Procedure used in this study.
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