Kahled smoking e-cig
April 15, 2021

Exposure to e-cigs in music videos associated with more e-cig use in real life

It has been well-established for over a decade that exposure to onscreen smoking in movies causes kids to smoke.

Now, Anuja Majumundar and colleagues at USC have used similar methods as in the early movie studies to show that the more e-cig promotions young adults (age 18-24) see in music videos the more likely they are to us e-cigs.

They asked a representative sample of California young adults whether they had seen any of 24 music videos that included e-cigarette product placement or imagery. (They did not ask about whether the respondents noticed e-cigarettes in the videos, which strengthens their results.) For example, they included the music video, “I’m the One” by DJ Khaled​, Justin Bieber, Quavo, Chance the Rapper & Lil Wayne that features Kanypens e-cigs.

They found that for every video including e-cigarettes that a respondent saw, the changes of past 30-day e-cigarette use increased by a factor of 1.20.

The effect depended on the “dose,” i.e., the number of e-cig containing music videos respondents saw. So, for someone who had seen 4 for the music videos (the average number respondents had seen), the risk of 30-day e-cigarette use increased by a factor of 1.20^4 = 2.08. The presence of a dose-response strengthens the conclusion that the e-cig imagery was linked to the e-cig use in real life.

They also found that among those with any exposure, people under 21 were more likely to report lifetime e-cig use than people 21 and older. In other words, these music videos were promoting e-cigs to people who were not old enough to legally buy e-cigs.

The authors controlled for demographics and online and offline exposure to advertisements for e-cigarettes, including in newspapers, magazines, billboards, convenience stores, supermarkets and gas stations. They also controlled for use of other tobacco products.

This study is cross-sectional (a snapshot in time), rather than longitudinal (following people forward in time), so the possibility of reverse-causality always exists. The fact is, however, that the first studies linking smoking in movies to smoking behavior were also cross-sectional. That is how most epidemiology starts.

The results are consistent with the results on movies, which are based on both cross-sectional and longitudinal studies. The fact that youth watch music videos over and over again also probably amplifies their effect.

When I asked Jon-Patrick Allem, the senior author, how they knew that there was “product placement” going on, he told me, “There are a number of ways to find this out. The simplest and most public way is by going to the brand website. They will promote the music video on the website and talk about sponsored content and sponsored artists.”

They aren’t even trying to hide it!

The question is, are the FDA, FTC, AGs or any other authority willing to intervene to block this targeting of youth through music videos?

Here is the abstract:

Background: The prevalence of electronic-cigarette (e-cigarette) product placement in music videos is on the rise and currently unregulated. This promotional activity is concerning given the popularity of music videos among young adults.

Aims: We examined associations between self-reported levels of exposure to music videos with any e-cigarette product placement or imagery and susceptibility to use e-cigarettes and e-cigarette use.

Method: A representative sample of young adults (18-24 years of age), residing in California (n = 1,280), completed online surveys assessing self-reported exposure to music videos with e-cigarette product placement or imagery and susceptibility to use e-cigarettes and e-cigarette use. Adjusted and weighted regression analyses were used for statistical analyses.

Results: Participants exposed to any e-cigarette product placement or imagery in music videos were more likely to report lifetime e-cigarette use (relative risk ratio [RRR]: 2.81) and past 30-day use (RRR: 3.64) compared with participants with no exposure. Additionally, participants with greater levels of exposure were more likely to report lifetime e-cigarette use (RRR: 1.13) and past 30-day use (RRR: 1.20) compared with participants with lower levels of exposure. Among those with any exposure, participants younger than 21 years of age (i.e., under the tobacco purchasing age in the United States) were more likely to report lifetime e-cigarette use (RRR: 4.68) compared with those aged 21 years and older.

Discussion and conclusion: Restricting e-cigarette product placement or imagery in music videos may minimize marketing exposure and risk for vaping among young adults, especially among those under the tobacco purchasing age.

The full citation is Majmundar A, Unger JB, Cruz TB, Kirkpatrick MG, Allem JP. Exposure to E-Cigarette Product Placement in Music Videos Is Associated With Vaping Among Young Adults. Health Educ Behav. 2021 Apr 6:10901981211003867. doi: 10.1177/10901981211003867. Epub ahead of print. PMID: 33821689. It is available here.

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