Exposure to Flavored Tobacco Advertising and Associations with Future Use in Young Adults: Implications for Health Equity

A potential ban on flavored tobacco products is a policy option to reduce tobacco product initiation by youth and young adults. However, few studies examine its potential to reduce disparities in vulnerable populations due to tobacco advertising exposure, perceptions of flavored products, and differential use. The purpose of this study is to address how targeted marketing of FTPs may influence perceptions of, susceptibility to and initiation of tobacco in a vulnerable population (recruited from 3 wards within Washington, DC with the highest smoking rates, % African American, and lowest SES) (VP) vs. a non-vulnerable population (non-VP) of young adults in Washington, DC. It will address the potential of a policy ban or restrictions on flavored tobacco products to reduce tobacco and, ultimately, cancer disparities and enhance equity in the distribution of tobacco marketing risk. The current study will build on the Elaboration Likelihood Model (ELM), a model of cognitive processing of how advertising results in persuasion. The ELM suggests that one way tobacco advertising works is by linking tobacco to `peripheral cues,' positive attributes including flavoring that may contribute to positive appraisal and lower harm perceptions of flavored products. Across a sample of n = 256 VP and non-VP young adult non-tobacco users, this multi-level study (store- and individual-level) will build on the ELM to examine differences in real-world exposure to FTP advertising, emphasizing point of sale (POS) exposure, using 14 days of ecological momentary assessment (EMA). It will examine the influence of exposure on self-reported perceptions of FTPs (lower harm, more appeal). Participants will be assessed at 2-weeks and 6- months post-baseline to examine differential impacts of FTP advertising and attitudes on susceptibility, intentions, and tobacco use patterns (for FTPs and non-FTPs) as a function of VP group status. POS exposure will be validated by photographs of tobacco advertising in stores visited by respondents. Our specific aims are to (1) Identify the frequency of FTP and non-FTP advertising, and number and types of products characterized by FTP descriptors (e.g., menthol, cherry) in tobacco retailers visited by VP and non-VP young adults, (2) Compare differences in harm perceptions and appeal of FTP vs non-FTP advertisements and descriptors across VP and non-VP young adults and (3) Examine the predictive utility of FTP advertising and descriptor exposure on susceptibility, intentions to use, and initiation of FTPs (and non-FTPs) at 6-month follow-up across VP and non-VP young adults. This unique approach to triangulate data at the store and individual cognitive level will yield timely information given the increase in use of FTPs and the need to identify new policies and approaches to combat tobacco disparities in vulnerable groups. Achieving the aims of this R21 will establish whether these associations exist and provide the foundation for a larger study developing interventions correcting FTP misperceptions, promoting FTP de-normalization among young adults and examining the likely impact of local policies to restrict FTP availability and advertising particularly in vulnerable communities. This study can also provide a basis for examining targeted marketing of other harmful products at POS