Young Adults' Responses to E-Cigarette Advertisements: An Examination for Potential Regulation.

Abstract

E-cigarette use among young adults is strongly influenced by marketing strategies. Given the U.S. Food and Drug Administration's authority to regulate E-cigarette marketing, this study identified which advertisements and specific features are most appealing to young adults to inform potential regulatory action. Using a within-subjects laboratory design, participants viewed 15 print E-cigarette advertisements from 3 brands (Blu, Juul, and MarkTen), each featuring combinations of people, descriptors, branding, and warnings during 2021-2022. Young adults (N=62; aged 18-26 years) who were susceptible to but not current E-cigarette users completed the study. While viewing advertisements, heart rate (attention) and eye tracking (visual attention) were continuously recorded. After each advertisement, participants rated perceived risk and motivation to avoid E-cigarettes. All participants completed the same advertisement-viewing task. Self-reported message perceptions and psychophysiological indicators of cognition and emotion were collected. Data were integrated using a multiattribute decision-making framework to identify advertisements with the highest overall appeal. Primary outcomes included perceived risk, motivation to avoid, heart rate deceleration, visual attention, and recognition accuracy. Data were analyzed from 2022 to 2025. Participants spent more time viewing descriptors and people than brand logos or warnings (p<0.001). Integrated rankings identified 2 Blu advertisements and 1 Juul advertisement as most appealing. People and descriptive language captured the most attention in E-cigarette advertisements. Limiting testimonials, switching language, and restricting advertisements to branding-only formats may reduce appeal among young adults and help prevent initiation.