Yale School of Medicine, Department of Psychiatry & The Consultation Center, 389 Whitney Avenue, New Haven, CT 06511, USA.
Yale School of Medicine, Department of Emergency Medicine, 464 Congress Avenue Suite 260, New Haven, CT 06519, USA.
Prev Med. 2018 Jul;112:193-198. doi: 10.1016/j.ypmed.2018.04.019. Epub 2018 Apr 17.
Among adolescents, low socioeconomic status (SES) is associated with greater exposure to tobacco cigarette advertising and cigarette use. However, associations among SES, e-cigarette advertising and e-cigarette use are not well understood. This study examined exposure to e-cigarette advertisements as a mediator of the relationship between SES and adolescent e-cigarette use. Adolescents (N = 3473; 51% Female) from 8 high schools in Connecticut completed an anonymous survey in Spring 2015. Mediation analysis was used to examine whether the total number of sources of recent e-cigarette advertising exposure (e.g., TV, radio, billboards, magazines, local stores [gas stations, convenience stores], vape shops, mall kiosks, tobacco shops, social media) mediated the association between SES (measured by the Family Affluence Scale) and past-month frequency of e-cigarette use. We clustered for school and controlled for other tobacco product use, age, sex, race/ethnicity and perceived social norms for e-cigarette use in the model. Our sample recently had seen advertisements via 2.1 (SD = 2.8) advertising channels. Mediation was supported (indirect effect: β = 0.01, SE = 0.00, 95% CI [0.001, 0.010], p = 0.02), such that higher SES was associated with greater recent advertising exposure, which, in turn, was associated with greater frequency of e-cigarette use. Our study suggests that regulations to reduce youth exposure to e-cigarette advertisement may be especially relevant to higher SES youth. Future research should examine these associations longitudinally and evaluate which types of advertisements target different SES groups.
在青少年中，较低的社会经济地位（SES）与更多地接触香烟广告和吸烟有关。然而，SES、电子烟广告和电子烟使用之间的关联尚未得到很好的理解。本研究调查了电子烟广告接触作为 SES 与青少年电子烟使用之间关系的中介因素。康涅狄格州 8 所高中的青少年（N=3473；51%为女性）在 2015 年春季完成了一项匿名调查。中介分析用于检验最近电子烟广告接触（例如，电视、广播、广告牌、杂志、当地商店[加油站、便利店]、电子烟商店、商场亭、烟草店、社交媒体）的总数是否在 SES（通过家庭富裕量表衡量）与过去一个月电子烟使用频率之间的关联中起中介作用。我们对学校进行了聚类，并在模型中控制了其他烟草制品使用、年龄、性别、种族/族裔和对电子烟使用的感知社会规范。我们的样本最近通过 2.1（SD=2.8）个广告渠道看到了广告。中介作用得到支持（间接效应：β=0.01，SE=0.00，95%CI[0.001，0.010]，p=0.02），即 SES 较高与近期广告接触较多相关，而近期广告接触较多又与电子烟使用频率较高相关。我们的研究表明，减少青少年接触电子烟广告的法规可能特别适用于 SES 较高的青少年。未来的研究应该从纵向角度研究这些关联，并评估哪些类型的广告针对不同的 SES 群体。
