Bidirectional associations between young adults' reported exposure to e-cigarette marketing and e-cigarette use.

aimsTo examine bidirectional associations between self-reported exposure to electronic nicotine delivery system (ENDS) marketing and ENDS use, over four 6-month follow-up surveys, among young adults.

designThe Marketing and Promotions Across Colleges in Texas project (M-PACT) is a cohort study that examined exposure to tobacco marketing and tobacco use behaviors among college students in Texas, United States. SETTING AND

participantsParticipants were 5478 students from 24 2-year and 4-year Texas colleges. Approximately 64% (n = 3506) of the cohort were non-white, 64% were female and the average age was 20 years. MEASUREMENTS: Students completed a baseline survey in Fall 2014/Spring 2015 and three subsequent surveys 6 months apart. Items assessed current ENDS use and self-reported exposure to ENDS marketing through the point-of-sale, on television, on the radio, on the internet and on billboards. A multi-level cross-lagged path model was used to examine the bidirectional associations between self-reported exposure to ENDS marketing and current ENDS use across the four waves, controlling for socio-demographics.

findingsSelf-reported exposure to ENDS marketing at each previous wave predicted ENDS use at each subsequent wave (β = 0.07-0.10, P < 0.001). ENDS use at waves 2 and 3 predicted self-reported exposure to ENDS marketing at wave 3 and 4, respectively (β = 0.07-0.09, P < 0.001). Although ENDS users were more likely than non-users to report exposure to ENDS marketing, self-reported exposure to ENDS marketing predicted subsequent ENDS use controlling for prior ENDS use.

conclusionSelf-reported exposure to electronic nicotine delivery system (ENDS) marketing was bidirectionally associated with past 30-day use of ENDS among young adult college students in Texas, USA from 2014/15 to 2016.