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Original Investigation
May 2018

Association Between Receptivity to Tobacco Advertising and Progression to Tobacco Use in Youth and Young Adults in the PATH Study

Author Affiliations
  • 1Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
  • 2Department of Family Medicine and Public Health, University of California, San Diego
  • 3C. Everett Koop Institute, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
  • 4Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
  • 5Westat, Rockville, Maryland
  • 6National Institute on Minority Health and Health Disparities, Bethesda, Maryland
  • 7National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
  • 8Kelly Government Solutions, Rockville, Maryland
  • 9Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland
  • 10Department of Health Education and Behavioral Science, Rutgers School of Public Health, New Brunswick, New Jersey
  • 11Department of Oncology, Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
  • 12Roswell Park Cancer Institute, Department of Health Behavior, Buffalo, New York
JAMA Pediatr. 2018;172(5):444-451. doi:10.1001/jamapediatrics.2017.5756
Key Points

Question  Is receptivity to advertising of e-cigarettes, cigarettes, cigars, and smokeless tobacco products a risk factor for trying tobacco products in youth and young adults?

Findings  In this population-based study including 10 989 participants, receptivity to tobacco advertising at wave 1 was significantly associated with committed never tobacco users aged 12 to 17 years progressing to susceptibility and tobacco product use at 1-year follow-up in wave 2. For never tobacco users aged 12 to 21 years at wave 1, receptivity to e-cigarette advertising was significantly associated with ever use of conventional cigarettes at wave 2.

Meaning  Receptivity to tobacco product advertising is associated with progression to tobacco use among young never tobacco users, and receptivity to e-cigarette marketing is associated with later conventional cigarette smoking.


Importance  Cigarette marketing contributes to initiation of cigarette smoking among young people, which has led to restrictions on use of cigarette advertising. However, little is known about other tobacco advertising and progression to tobacco use in youth and young adults.

Objective  To investigate whether receptivity to tobacco advertising among youth and young adults is associated with progression (being a susceptible never user or ever user) to use of the product advertised, as well as conventional cigarette smoking.

Design, Setting, and Participants  The Population Assessment of Tobacco and Health (PATH) Study at wave 1 (2013-2014) and 1-year follow-up at wave 2 (2014-2015) was conducted in a US population-based sample of never tobacco users aged 12 to 24 years from wave 1 of the PATH Study (N = 10 989). Household interviews using audio computer-assisted self-interviews were conducted.

Exposures  Advertising for conventional cigarettes, electronic cigarettes (e-cigarettes), cigars, and smokeless tobacco products at wave 1.

Main Outcomes and Measures  Progression to susceptibility or ever tobacco use at 1-year follow-up in wave 2.

Results  Of the 10 989 participants (5410 male [weighted percentage, 48.3%]; 5579 female [weighted percentage, 51.7%]), receptivity to any tobacco advertising at wave 1 was high for those aged 12 to 14 years (44.0%; 95% confidence limit [CL], 42.6%-45.4%) but highest for those aged 18 to 21 years (68.7%; 95% CL, 64.9%-72.2%). e-Cigarette advertising had the highest receptivity among all age groups. For those aged 12 to 17 years, susceptibility to use a product at wave 1 was significantly associated with product use at wave 2 for conventional cigarettes, e-cigarettes, cigars, and smokeless tobacco products. Among committed never users aged 12 to 17 years at wave 1, any receptivity was associated with progression toward use of the product at wave 2 (conventional cigarettes: adjusted odds ratio [AOR], 1.43; 95% CL, 1.23-1.65; e-cigarettes: AOR, 1.62; 95% CL, 1.41-1.85; cigars: AOR, 2.01; 95% CL, 1.62-2.49; and smokeless [males only]: AOR, 1.42; 95% CL, 1.07-1.89) and with use of the product (conventional cigarettes: AOR, 1.54; 95% CL, 1.03-2.32; e-cigarettes: AOR, 1.45; 95% CL, 1.19-1.75; cigars: AOR, 2.07; 95% CL, 1.26-3.40). Compared with those not receptive to any product advertising, receptivity to e-cigarette advertising, but not to cigarette advertising, was independently associated with those aged 12 to 21 years having used a cigarette at wave 2 (AOR, 1.60; 95% CL, 1.08-2.38).

Conclusions and Relevance  Receptivity to tobacco advertising was significantly associated with progression toward use in adolescents. Receptivity was highest for e-cigarette advertising and was associated with trying a cigarette.