title: Associations of attitudes towards electronic cigarettes with advertisement exposure and social determinants: a cross sectional study.
abstract: BACKGROUND
  The exposure of young adults to electronic cigarette (e-cigarette) advertisements has risen rapidly. E-cigarette ads have been shown to increase short term perceived acceptability of using e-cigarettes in places where traditional cigarettes are banned. We set out to investigate if advertising exposure was related to perceptions of harm, addictiveness, and acceptability of use of e-cigarettes in places where traditional cigarettes are banned.
  
  
  METHODS
  Using a cross-sectional design, 6037 students at a large Midwestern university between the ages of 18-24 were surveyed about e-cigarette use and smoking status. Bivariate analyses were performed associating perception of harm, addictiveness, and acceptability of e-cigarette use in places where smoking is banned with demographic and other background factors, and e-cigarette advertising exposure through different media channels. Logistic regression analyses were used to explore the relationship of these factors on perceptions of harm, addictiveness and acceptability of e-cigarette use in places where smoking is banned.
  
  
  RESULTS
  More than a quarter (27.4%) of respondents had used an e-cigarette, greater than half (53.2%) had seen an advertisement on TV and 42.0% had seen an advertisement on the Internet. Logistic regressions revealed that being white, male, an e-cigarette user, a smoker, having a mother who smoked, and Internet advertisement exposure were associated with lower perceived harm of e-cigarettes. The same factors, plus having seen advertisements on TV, were associated with increased likelihood of perceiving e-cigarette use in bars, stores, at work and in a dorm as acceptable. Perceiving use of e-cigarettes as acceptable in classrooms was also associated with the aforementioned factors and also included race. Only being male and an e-cigarette user were associated with lower perceived addictiveness of e-cigarettes.
  
  
  CONCLUSIONS
  E-cigarette use is increasing in adolescents and young adults, as is exposure to e-cigarette advertising. Independent of nicotine use and demographics factors, e-cigarette advertising is associated with increased beliefs in acceptability of e-cigarette use in places where cigarettes are banned. E-cigarette advertisements may be responsible for normalizing e-cigarette use. Exposure to internet e-cigarette advertisements was associated with lower perceived harm; this may be due to the false health claims often made in internet advertisements.
authors.affiliation: College of Public Health, Kent State University, 800 E. Summit St, Kent, 44240 OH USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Reinhold
authors.affiliation: Health Policy and Management, College of Public Health, Kent State University, 800 E. Summit St, Kent, 44240 OH USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Fischbein
authors.affiliation: College of Public Health, Kent State University, 800 E. Summit St, Kent, 44240 OH USA.
authors.forename: Surya Sruthi
authors.initials: SS
authors.lastname: Bhamidipalli
authors.affiliation: College of Public Health, Kent State University, 800 E. Summit St, Kent, 44240 OH USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bryant
authors.affiliation: College of Public Health, Kent State University, 800 E. Summit St, Kent, 44240 OH USA.
authors.forename: Deric R
authors.initials: DR
authors.lastname: Kenne
keywords: Adolescents; Advertising; E-cigarettes; Electronic Cigarettes; Harm; Nicotine; Perceptions; Transitional youth