Tobacco use is the leading cause of preventable death worldwide and accounts for more than 480,000 deaths in the U.S. every year. Electronic cigarettes, or e-cigarettes, are novel products that mimic the look and action of a traditional cigarette, vaporizing a mixture of nicotine and other chemicals to produce a smoke-like vapor for the user to inhale. E-cigarettes are marketed as a means for tobacco smokers to self-administer nicotine without most other tobacco toxicants, but may also be acting as a means of introducing new users to nicotine, who may later become tobacco users.

This is troubling because of e-cigarettes’ rising popularity among young people. “Monitoring the Future,” a December 2014 national survey funded by the National Institute on Drug Abuse, part of the National Institutes of Health, found that 17.1 percent of 12th-graders had tried an e-cigarette, compared with only 13.6 percent who had tried a traditional tobacco cigarette. In 10th-graders, the ratio was 16.2 percent to 7 percent and in eighth-graders, it was 8.7 percent to 4 percent.

Andrew J. Barnes, Ph.D., assistant professor in the Department of Healthcare Policy and Research in the School of Medicine, and Caroline Cobb, Ph.D., assistant professor in the Department of Psychology in the College of Humanities and Sciences, believe this increase may be due to the unrestricted nature of e-cigarette advertising.

“Unlike cigarettes, e-cigarette advertising is largely unregulated, exposing many young people in our communities to savvy and likely effective messages promoting these electronic nicotine delivery products,” says Barnes. “Further, young people are attracted to novel technologies and experimentation with substances and these technologies are becoming better and better at delivering a highly addictive substance in a variety of flavors, many of which appeal to youth; for example, candy.”

In April 2014, the US Food and Drug Administration Center on Tobacco Products proposed that e-cigarettes be subject to FDA regulation. The FDA’s proposal, among other things, highlighted an interest in evidence to inform the regulation of advertising.

Barnes and Cobb are co-principal investigators on a study, “Categorization and Effects of e-cigarette Ads on Attitudes, Intentions and Abuse Liability in Youth,” which is supported by a $450,000 grant from the Virginia Foundation for Healthy Youth.

Barnes’ and Cobb’s subjects will be 1,400 young people, ages 13–18, who are either current or potential smokers.

“We are currently conducting a content analysis on nearly 500 e-cigarette print, billboard, email and online ads to determine common themes in the current market,” says Barnes.

Possible themes in the advertising include the sociability of using e-cigarettes, the perceived safety of e-cigarettes when compared to traditional tobacco cigarettes, or the idea of e-cigarettes representing aspects of freedom.

“Participants will be presented with ads in one of the three most common themes identified from the content analysis of e-cigarette ads, or will be presented with a control ad,” says Barnes. After being presented with the advertisement, participants will answer questions about their attitudes and intentions with regard to e-cigarettes, thereby measuring the impact of the advertising themes.

The study will conclude in July 2018 and Barnes hopes the results will play a role in reducing the damage caused by e-cigarette and tobacco usage.

“We hope this study will inform local, state, and federal policies to reduce the harm potential of e-cigarettes and other novel tobacco products that are increasingly being abused by young people,” he says.