Article Text

Download PDFPDF
Linking the content to demographic reach of online advertising of electronic nicotine delivery systems
  1. David S Timberlake1,
  2. Dmitriy Nikitin2,
  3. Jennifer Garcia-Cano1,
  4. Samantha Cino1,
  5. Margarita Savkina1,
  6. Cornelia Pechmann3
  1. 1 Program in Public Health, University of California, Irvine, California, USA
  2. 2 Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  3. 3 The Paul Merage School of Business, University of California, Irvine, California, USA
  1. Correspondence to Dr David S Timberlake, Program in Public Health, University of California, Irvine, Anteater Instruction & Research Building, 2nd Floor, Room 2044, Irvine, CA, USA; dtimberl{at}


Introduction Recent studies have separately examined the content and demographic reach of the advertising of electronic nicotine delivery systems (ENDS). No study to our knowledge has linked the two in investigating whether racial/ethnic groups are differentially exposed to the comparative messages conveyed in online ENDS advertisements.

Methods 932 unique ENDS advertisements (6311 total), which were posted on 3435 websites between December, 2009 and October, 2015, were categorized as either comparative or non-comparative with respect to the traditional cigarette. The race/ethnicity of website visitors was obtained from a proprietary source and used in constructing variables for racial/ethnic viewership. The variables for advertising content and website racial/ethnic viewership were then linked yielding a final sample of 551 unique ENDS advertisements (2498 total) on 1206 websites. A two-level hierarchical generalized linear model, used in estimating website racial/ethnic viewership as a predictor of comparative advertising, accounted for the nesting of advertisements (level 1) within 152 ENDS brands (level 2).

Results In contrast to racial/ethnic minorities, a greater proportion of non-Hispanic whites visited websites with ENDS advertisements than the overall proportion of nonHispanic white U.S. Internet users. Yet, it was the advertisements on websites that appealed to Hispanics that had greater odds of comparing ENDS to traditional cigarettes.

Conclusions The lower exposure to ENDS advertising among racial/ethnic minorities versus non-Hispanic whites is consistent with survey data. Yet, the greater odds of comparative advertising of ENDS on websites that appeal to racial/ethnic minorities (ie, Hispanics) could impact the longterm health of minority smokers.

Implications This study’s findings have important implications for the uptake of ENDS among minority smokers. If the comparative advertising yields greater interest and eventual use of ENDS, then minority smokers could either benefit from smoking cessation because they switch to ENDS, or adopt dual tobacco use. The fate of comparative advertising of ENDS versus the traditional cigarette will depend on the Food and Drug Administration enforcement of its deeming rules and the ensuing changes in the ENDS marketplace.

  • Advertising and Promotion
  • Electronic nicotine delivery devices
  • Prevention

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors DT, DN and CP developed the research question and study methodology. JGC, SC and MS coded the online ENDS advertisements and compiled information on website racial/ethnic appeal and other website characteristics. DT conducted most of the analyses, and DT and DN wrote the manuscript. CP was instrumental in editing the manuscript and providing input on the marketing aspects of the study.

  • Funding Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award numbers P20 CA174292 and P20 CA174188.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ’BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.