Convenience Store Access and E-cigarette Advertising Exposure Is Associated With Future E-cigarette Initiation Among Tobacco-Naïve Youth in the PATH Study (2013–2016)

Purpose: The association between e-cigarette marketing exposure and youth e-cigarette initiation is not well understood. This study examines whether convenience store access, exposure to retail e-cigarette marketing, and having a favorite e-cigarette ad before e-cigarette use is associated with susceptibility to use and future e-cigarette initiation in a national longitudinal study of youth. Methods: A nationally representative longitudinal cohort of youth in the Population Assessment of Tobacco and Health study (12–17 years) was followed up over three waves of annual data collection (2013–2016). Tobacco-naïve (wave 1) and e-cigarette-naïve (wave 2) youth (n = 6,470) were included. Marketing exposure at wave 2 was examined in association with e-cigarette susceptibility (wave 2) and e-cigarette initiation (wave 3) using adjusted logistic regression models. Analysis occurred in 2019. Results: Youth visiting convenience stores at least weekly (vs. never) had 1.51 times the odds of e-cigarette susceptibility (95% confidence interval [CI]: 1.25, 1.81) and 1.79 times the odds of e-cigarette initiation (95% CI: 1.29, 2.48). Noticing a retail e-cigarette ad (vs. not noticing) was associated with e-cigarette susceptibility (adjusted odds ratio [AOR] 1.36, 95% CI: 1.18, 1.57), but not initiation. Youth reporting a favorite branded e-cigarette ad had greater odds of both susceptibility (AOR 1.31, 95% CI, 1.10, 1.56) and e-cigarette initiation (AOR 1.60, 95% CI: 1.18, 2.17) compared to youth without a favorite ad. Conclusions: Tobacco-naïve youth with frequent convenience store access and exposure to e-cigarette marketing were at greater risk of e-cigarette susceptibility and progression to e-cigarette initiation over a 2-year period. Policies to restrict retailer locations and e-cigarette marketing could enhance youth e-cigarette use prevention efforts.