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What is the impact of e-cigarette adverts on children's perceptions of tobacco smoking? An experimental study
  1. D C Petrescu1,
  2. M Vasiljevic1,
  3. J K Pepper2,3,
  4. K M Ribisl2,4,
  5. T M Marteau1
  1. 1Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
  2. 2Department of Health Behaviour, UNC Gillings School of Global Public Health, Cambridge, UK
  3. 3RTI International, Research Triangle Park, North Carolina, USA
  4. 4Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina, USA
  1. Correspondence to Professor T M Marteau, Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Addenbrooke's Hospital, Cambridge CB2 0SR, UK; tm388{at}


Objective Exposure to e-cigarette adverts increases children's positive attitudes towards using them. Given the similarity in appearance between e-cigarettes and tobacco cigarettes, we examined whether exposure to e-cigarette adverts has a cross-product impact on perceptions and attitudes towards smoking tobacco cigarettes.

Methods Children aged 11–16 (n=564) were interviewed in their homes and randomised to one of three groups: two groups saw different sets of 10 images of e-cigarette adverts and one group saw no adverts. Of the 20 e-cigarette adverts, 10 depicted the product as glamorous and 10 depicted it as healthy. The children then self-completed a questionnaire assessing perceived appeal, harms and benefits of smoking tobacco cigarettes.

Results The analyses were conducted on 411 children who reported never having smoked tobacco cigarettes or used e-cigarettes. Exposure to the adverts had no impact on the appeal or perceived benefits of smoking tobacco cigarettes. While the perceived harm of smoking more than 10 cigarettes per day was similar across groups, those exposed to either set of adverts perceived the harms of smoking one or two tobacco cigarettes occasionally to be lower than those in the control group.

Conclusions This study provides the first evidence that exposure to e-cigarette adverts might influence children's perceptions of smoking tobacco cigarettes, reducing their perceived harm of occasional smoking. These results suggest the potential for e-cigarette adverts to undermine tobacco control efforts by reducing a potential barrier (ie, beliefs about harm) to occasional smoking.

  • Electronic nicotine delivery devices
  • Advertising and Promotion
  • Priority/special populations

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