Visibility of e-cigarette displays could influence adolescents' perception of the dangers of tobacco

A British study indicates that the types of e-cigarette displays to which children are exposed may have little direct influence on their susceptibility to initiating tobacco or e-cigarettes, but may have an indirect influence on their perception of the dangers of tobacco.

Numerous studies have shown the influence of tobacco displays on smokers' purchasing behavior and their reduced intention to quit smoking.[1], as well as on smoking initiation and susceptibility among young people[2]. These have notably led to the banning of visible tobacco product displays in several countries, including the United Kingdom, Iceland, Canada and Australia. In these countries, however, e-cigarettes and their products remained on visible displays, generally adjacent to hidden tobacco product displays.

Given the limited research on this topic, British researchers implemented a randomized experimental design to assess the influence of electronic cigarette displays on adolescents' perceptions of them and their impact on their perception of cigarettes and the harms of smoking.[3].

A randomized experimental study of exposure to e-cigarette displays

The randomized experimental study tested several online e-cigarette display image designs with a sample of 1,034 English adolescents aged 13 to 17. The visuals differed according to the visibility of the e-cigarette display (high or low) and the number of vaping products present (+/- 75%) among other non-tobacco or non-vaping products (patches, confectionery, drinks).

Of the various hypotheses tested, the researchers were unable to demonstrate a link between exposure to e-cigarette displays and the susceptibility of adolescents who had not experimented with tobacco to start smoking, nor with the susceptibility of non-vapers to start vaping. However, among the subjects exposed to visuals containing a higher proportion of e-cigarettes among the products sold, there is a subgroup of adolescents who most often frequent supermarkets and other retail outlets who show a higher susceptibility to start smoking. Since the experimental study focused on short exposures to display visuals, the results could also prove more significant in a real-life setting depending on certain population categories or retail outlets more targeted by the tobacco and vaping industries.

An indirect link with a lower perception of the dangers of tobacco

While the direct influence of visual exposure on the susceptibility to becoming a smoker has not been confirmed, one of the lessons of this experimental study is to highlight the indirect influences and cross-effects of exposure to the products. It thus shows that the high visibility of e-cigarette displays tends to reduce the perception of the dangers of smoking. However, the low perception of the dangers of smoking and the susceptibility to becoming a smoker are established indicators of smoking initiation.[4]. The high visibility of e-cigarette displays being, according to an observational study, the norm in most English establishments that sell them[5], repeated exposure to the sight of these products could modify cognitive perceptions towards tobacco. Variations in the proportion of e-cigarettes among the exposed products, on the other hand, seem to have little or no impact on the susceptibility to becoming a smoker or vaper.

The high visibility of e-cigarette displays and their proximity to tobacco products therefore appear to be a factor to consider in public policy. Regarding the potential benefits of these e-cigarettes for adults wishing to quit smoking, this must be balanced against the need to better protect children from the risk of them becoming vapers and/or smokers. The authors here advocate for a review of the rules governing displays of e-cigarettes and tobacco products.

Keywords: displays, e-cigarettes, teenagers, United Kingdom

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[1] Robertson L, McGee R, Marsh L, et al. A systematic review on the impact of point-of-sale tobacco promotion on smoking. Nicotine Tob Res 2015;17:2–17.

[2] Mackintosh AM, Moodie C, Hastings G. The association between point-of-sale displays and youth smoking susceptibility. Nicotine Tob Res 2012;14:616–20.

[3] Blackwell AKM, Pilling MA, De-Loyde K, et al. Impact of e-cigarette retail displays on attitudes to smoking and vaping in children: an online experimental study, Tob Control, Epub ahead of print: 04/14/2022, doi:10.1136/tobaccocontrol-2021-056980.

[4] Berg CJ, Romero DR, Pulvers K. Perceived harm of tobacco products and individual schemas of a smoker in relation to change in tobacco product use over one year among young adults. Subst Use Misuse 2015;50:90–8.

[5] Brocklebank LA, Blackwell AKM, Marteau TM, et al. Electronic cigarette and smoking paraphernalia point of sale displays: an observational study in England. Tob Control 2021, Epub ahead of print: April 14, 2022. doi:10.1136/tobaccocontrol-2020-056314.