E-cigarette Advertising Exposure, Explicit and Implicit Harm Perceptions, and E-Cigarette use Susceptibility Among Non-Smoking Young Adults.

Introduction: This study tested whether exposure to e-cigarette advertising increases e-cigarette use susceptibility among non-smoking young adults by promoting explicit and implicit attitudes towards e-cigarettes as a safer and healthier alternative to combustible cigarettes.

Methods: Young adult current non-smokers who had never used an e-cigarette (N = 393; Mean age = 22.1, Standard Deviation = 3.9; 66% Women) were randomly assigned to one of the 3 conditions that involved viewing real-world, print e-cigarette ads. Two of the 3 conditions were experimental conditions where ads with different predominant themes [harm-reduction ("Health") vs. social enhancement ("Social") focused] were interspersed among ads of everyday objects. The third condition was the control condition involving ads of everyday objects only. Participants provided data on explicit (i.e., self-reported harm perceptions) and implicit (i.e., Implicit Association Test) attitudes towards e-cigarette use and e-cigarette use intentions. Hypotheses were tested using structural equation modeling.

Results: Relative to Control participants, participants in Health and Social conditions were more likely to show higher implicit attitudes towards e-cigarettes as a safer alternative to cigarettes. Only the Social condition, relative to Control, had a significant effect on lower explicit harm perceptions of e-cigarette versus cigarette use. The Social condition had a significant indirect effect on e-cigarette use susceptibility, mediated by explicit harm perceptions.

Conclusions: Social enhancement-themed ads may communicate the reduced-harm messages more strongly among young adults so as to affect both explicit and implicit attitudes and, through these, e-cigarette use susceptibility. Regulatory bodies may need to scrutinize reduced-harm claims communicated through social enhancement-themed ads.