E-cigarette school policies, advertising, and use among Texas adolescents

This study examined the effect of school e-cigarette policies and e-cigarette advertising on TV, radio, billboards, retail stores, internet, and an index score of all these types on e-cigarette use behaviors. In the first paper, policies on e-cigarettes from TATAMS schools (n=72) were obtained and an administrator from each participating TATAMS school in this study (n=54) completed the E-cigarette Policy Interview. No statistically significant associations were found between the presence of an e-cigarette school policy, the written policy index, and both administrator response indexes and any of the weighted proportions of adolescent 1) e-cigarette use; 2) susceptibility to e-cigarette use; and 3) perceptions of peer e-cigarette use. This is the first known study to look at e-cigarette school policy and potential administrator enforcement of these policies and provides the basis for future research using longitudinal designs and updated administrator enforcement to observe these associations over time. In the second paper, the effect of self-reported exposure to e-cigarette advertisements on perceived harm and addictiveness to e-cigarettes in adolescents were examined. An association was found between high self-reported exposure to TV, radio, and retail store e-cigarette advertising and perceiving no harm six months later. Unexpectedly, high self-reported exposure to radio, billboard, internet, and the index score of e-cigarette advertising was associated with perceived addictiveness to e-cigarettes in cross-sectional analyses, yet no statistically significant associations remained in longitudinal analyses. In the third paper, the effect of self-reported exposure to e-cigarette advertisements on past 30 day e-cigarette use and susceptibility to e-cigarettes in adolescents were analyzed. High self-reported exposure to TV, retail store, and the index score e-cigarette advertisements was associated with increased odds of past 30 day e-cigarettes use in cross-sectional models, while retail store exposure remained statistically significant in longitudinal analysis. Finally, high self-reported exposure to all e-cigarette advertising types was associated with increased odds of susceptibility to e-cigarette use in cross-sectional analyses, while the internet and index score e-cigarette advertising exposures remained statistically significant in the longitudinal models. The results from the second and third papers provide scientific rationale to inform the FDA in support of regulation of e-cigarette advertising to reduce adolescent exposure to the same