Share of advertising voice at the point-of-sale and its influence on at-risk students' use of alternative tobacco products.

Introduction: As adolescent tobacco use shifts from traditional cigarettes to alternative products, it is important to understand the influence of point-of-sale (POS) advertising on product use. This research investigated whether the percentage of POS advertising for a particular product, known as the share of advertising voice (SAV), moderated the relationship between exposure to POS tobacco advertisements and tobacco use among at-risk youth.

Methods: Longitudinal self-report data from 746 students attending 20 alternative high schools in southern California was merged with observational data cataloging 2,101 advertisements for cigarettes, e-cigarettes, cigars, and smokeless tobacco from 87 tobacco retail outlets within a half-mile of the schools. Four multilevel Poisson regression models examined whether SAV interacted with POS tobacco advertising exposure to influence the use of tobacco products one year later.

Results: Adolescent exposure to POS tobacco advertisements was significantly associated with increased use of all four tobacco products (p < .02). When SAV was added to the model as a moderator the results showed a significant interaction, such that increasing the SAV for e-cigarettes was associated with greater use of that product (B = 0.27, SE = 0.07, p < .001). The same moderating effect was found for smokeless tobacco (B = 0.56, SE = 0.19, p = .004) but no moderating effect was observed for cigarettes or cigars.

Conclusion: POS SAV has the potential to influence at-risk students' use of alternative tobacco products and may be a contributing factor to recent nationwide shifts in youth tobacco use.