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Youth-appealing features in popular e-cigarette brand advertising in the USA after heightened scrutiny in 2018
  1. Jessica Liu1,
  2. Coralia Vázquez-Otero2,
  3. Micah L Berman3,
  4. Elise M Stevens4
  1. 1 Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  2. 2 Department of Public Health, College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, Texas, USA
  3. 3 College of Public Health & Moritz College of Law, Ohio State University, Columbus, Ohio, USA
  4. 4 Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  1. Correspondence to Jessica Liu, Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, MA 02115, USA; jessica_liu{at}


Purpose Youth electronic cigarette (e-cigarette) use remains high in the USA, and advertising is a contributor. The purpose of this study was to identify themes and characteristics of popular e-cigarette companies’ advertising after e-cigarette companies became more highly scrutinised in 2018.

Methods Using a systematic, quantitative content analysis, three trained coders coded e-cigarette advertisements from JUUL, Puff Bar, Vuse and Blu from 2019 and 2020. Based on previous work, they coded for: type of advertisement, flavours, promotions, product cues, descriptors, claims, imagery, youth-oriented themes and sensational appeals.

Results Of the 401 e-cigarette advertisements, the majority were emails (38.2%) and Instagram posts (30.9%). Over half (53.6%) showed flavours other than tobacco, with Puff Bar leading the brands (70.2%; p<0.001). The most frequently used product cues were showing the product (51.4%) or packaging (42.4%). The most common claim was being an alternative to smoking (14.2%). The most frequently used imagery was fruit (14.0%), employed most by Puff Bar (p<0.001). The only youth-oriented theme present was humour (4.2%). Positive sensations (eg, good taste, good smell or satisfying; 17.1%) was the most common form of appeal, with Puff Bar using it at the highest frequency (p<0.001).

Conclusion Even with heightened scrutiny of e-cigarette brands, advertisements still included youth-appealing content such as flavours, fruit imagery and positive sensations. Puff Bar led in all these categories, and it rapidly gained market share after market leader JUUL limited the sales of its flavoured products. Research should continue to monitor the characteristics of e-cigarette advertisements and consider their impact on youth.

  • prevention
  • nicotine
  • advertising and promotion

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  • Contributors JL, CV-O and EMS contributed to the design and conceptualisation of the research study, to the analysis of the results and to the writing of the manuscript. MB revised the manuscript and contributed to the interpretation of the results.

  • Funding This work was funded by the National Institute on Drug Abuse (K99DA046563; E. Stevens, PI). CV-O and JL were funded by the Cancer Prevention Fellowship from the National Cancer Institute and Harvard T.H. Chan School of Public Health – National Institutes of Health grant number 2T32CA057711-27.

  • Disclaimer Its contents are solely the responsibility of the authors and do 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.