A Mediation Model of the Impact of Electronic Nicotine Delivery Systems (ENDS) Point-of-Sale Marketing on Ends Use Among College Students

Introduction: Previous research has found that exposure to point-of-sale (POS) tobacco marketing predicts tobacco use, however, little research has examined the impact of POS marketing for electronic nicotine delivery systems (ENDS) on ENDS use through theoretically-informed mediators. The purpose of this study was to determine if the impact of ENDS POS marketing on ENDS use 2 years later was mediated by perceived harmfulness, addictiveness, and social acceptability of ENDS among college students.

Methods: Participants were 5,482 students (64% female; 36% white; mean age=21) from 24 2- and 4-year colleges in Texas participating in a six-wave longitudinal study (2014-2017) with data from at least one wave included in the present analysis. Current ENDS use (yes/no) was assessed with one question at wave 6 (spring, 2017). POS marketing exposure at wave 2 (spring, 2015) was assessed with an index including objective counts of ENDS advertisements at tobacco retail outlets within a mile of each college multiplied by each student’s weekly store visit frequency, converted into a z-score. Meditators were assessed at wave 4 (spring 2016) with one item each. Social acceptability: “How socially acceptable is it for people your age to use ENDS?,” response options ranged from “Totally unacceptable” (1) to “Totally acceptable” (5). Perceived addictiveness: “How addictive is/are ENDS?,” responses included “Not at all addictive” (1) to “Very addictive” (3). Perceived harmfulness: “How harmful are ENDS products to health?,” responses included “Not at all harmful” (1) to “Extremely harmful” (4). Mixed-effects path analyses were used, with college as the random effect, controlling for baseline sex, age, race/ethnicity, current ENDS use, and college type (four vs two year).

Results: The model fit the data well, the chi-square was not significant (p=.08), the CFI was .98, and the RMSEA was .01. Exposure to ENDS advertisements predicted social acceptability of ENDS one year later (β=.02, p<.05) which then predicted current ENDS use one year later (β=.22, p<.001). Additionally, the indirect effect was significant (β=.01, p<.05). Exposure to ENDS advertisements did not predict perceived addictiveness or harmfulness of ENDS, although both predicted ENDS use (addictiveness: β=-.04, p<.05; harmfulness: β=-15, p<.001). ENDS POS marketing did not directly predict ENDS use two years later.

Conclusions: ENDS marketing, while highly prevalent at the POS, is largely unregulated. ENDS POS marketing works to influence ENDS use by increasing perceptions of the social acceptability of ENDS products. Policies to limit exposure at the POS are needed. Interventions with college students should address messages in ENDS marketing that might promote the social acceptability of these products.