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Use of electronic cigarettes (e-cigarettes) has increased significantly in the past 2 years1 ,2 and sales are estimated to reach $10 billion by 2017.3 All of the major tobacco companies have recently introduced their own e-cigarette and e-cigar brands into the tobacco marketplace or have plans to do so in the near future.4–9 News reports suggest that tobacco and e-cigarette companies have begun to significantly expand e-cigarette product distribution in retail channels in the past year.10 ,11 Many e-cigarette manufacturers, such as V2 Cigs, are expanding their products into the global market, selling them in Europe, India, Africa and the Middle East.12 While tobacco control stakeholders are learning more about how e-cigarettes are used and promoted, there is very little published research to date on the advertising and promotion of e-cigarettes in the retail environment.13
A pilot study was conducted from February to July 2013 to examine tobacco point-of-sale advertising and promotion in Central Harlem, New York City, a predominantly low- to moderate-income, African-American area.14 ,15 Central Harlem includes 156 currently operating stores licensed to sell tobacco, which serve a local population of approximately 165 000 people over a 2.1 square mile area.16 Survey data were collected on all stores including e-cigarette advertising and availability, as well as photos of the exterior and interior of the retail environment.
Among all stores, 26% had e-cigarette advertising on the exterior of the store. Among those that were open at the time of the survey (n=152), 45% sold e-cigarettes and 52% of these stores sold flavoured e-cigarettes. Photos of the retail environment show e-cigarette advertisements located less than 3 feet above the ground at the eye-level of children and feature products in flavours, which in this study were characterised as menthol, strawberry, blueberry, wine or similar flavours (figures 1⇓–3). Flavoured tobacco products are of concern given their increased appeal to youth.17–19 Characterising flavours are banned in traditional cigarettes, with the exception of menthol, but are not banned in e-cigarettes.20 ,21
The observed incidence of e-cigarette advertising found in Central Harlem confirms the growing prevalence of these tobacco products in the retail environment. The effects of industry advertising and promotion of e-cigarettes are already evident. One nationally representative study of US adults aged 18 and older recently found that African-Americans had the greatest increase in awareness of e-cigarettes (95%) as compared with other racial/ethnic groups.1 This may be due to targeted advertising and promotion of e-cigarettes, particularly in African-American neighbourhoods.
e-Cigarettes are currently unregulated by the Food and Drug Administration under the 2009 Family Smoking Prevention and Tobacco Control Act.20 While the individual use of e-cigarettes is likely less harmful than the use of combustible cigarettes, the public health impact of e-cigarette use is unclear, with concerns that e-cigarette use may encourage polytobacco use, delay cessation or renormalise tobacco use. Although the Food and Drug Administration has put forth its intention to regulate e-cigarettes,22 e-cigarette manufacturers are currently promoting their products aggressively through many channels and with few restrictions. Given the influence of retail tobacco advertising on initiation and use,23–25 it is likely e-cigarette advertising will have a similar impact.5 ,26 Thus, there is an urgent need for further research to examine how e-cigarettes are being advertised and promoted, particularly in the retail environment.
Specific measures relevant to e-cigarettes that could be included in future store audits include measurement of the 4 Ps, product, price, promotion and place, as they pertain to both e-cigarettes and e-cigarette advertisements. For example, whether or not e-cigarettes and e-cigarette advertisement are located below 3 feet at the eye level of children should be included. It is also crucial that future surveys include information on store location—store address, zip code or census tract—so that survey data can be linked to neighbourhood data, allowing for the examination of targeting of specific demographic groups. Additionally, questions about the content of e-cigarette advertisements and packaging, such as the presence of harm-reduction messages or health claims, should be included. Future research using measures specific to the promotion of e-cigarettes is critical to help inform future policies at both the local and national levels.
The authors would like to thank the Harlem Point-of-Sale Surveillance Evaluation (POSSE) Community Advisory Board for their participation in this project.
Contributors JC, JM-H, DV, TRK and AA designed the study and data collection system. OG and JC conceived and wrote the paper. JM-H, AA, TRK and DV provided substantial feedback on the paper.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
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