Methods: In phase 1, a scoping review was conducted to identify various influences on e-cigarette initiation and use among youth. Influences of youth vaping were extracted from articles by two reviewers using open coding, and then themes were generated and refined by the research team. Results of the scoping review analysis were used to informed the development of a coding framework. In phase 2, the coding framework was used to perform a content analysis of industry-driven e-cigarette advertisements broadcast on two popular television channels (Discovery and AMC).
Results: In phase 1, a total of 20 articles met the inclusion criteria and were reviewed. The resultant framework consisted of 16 key influences on e-cigarette uptake among youth, which were categorized into four main themes: personal (e.g. curiosity), relational (e.g. peer use), environmental (e.g. ease of access), and product-related (e.g. discreet use) factors. In phase 2, 38 e-cigarette advertisements were collected from ispot.tv, representing 11 popular e-cigarette brands (e.g. JUUL, BLU). All of the advertisements tapped into at least one of the cited influences of youth e-cigarette uptake, with most including on average 4 (SD=0.31) different influences. Among the advertisements, product and relational factors were the most commonly seen influences (97.4% (n=37) and 52.6% (n=20), respectively). For example, the scoping review revealed that youth were 1.76 times more likely to try vaping because it could be hidden from adults and the context analysis found that nearly half of the advertisements highlighted the product as being discreet or undetectable (e.g. no smell).
Conclusions and implications: The findings bring forward tangible strategies employed by e-cigarette companies to recruit youth into vaping by tapping into the multi-dimensional influences on youth uptake of e-cigarettes. Thus, these findings have important implications for developing effective anti-vaping messages and assisting social work professionals in providing and developing more comprehensive prevention and cessation support as it relates to e-cigarette use. Understanding this is vital to the development of cohesive strategies that help combat these pro-vaping messages.