Marc Boudreaux

Researchers from the Yale Tobacco Center of Regulatory Science found in a recent study that advertisements for flavored e-cigarettes may override negative perceptions of tobacco products, especially in youth.

Their brains process these advertisements as they would images of sweets or fruit, the study found. Promoting flavors like “skittles,” “strawberrylicious” and “juicy fruit,” flavored e-cigarette advertisements also affect warning label perception, according to the medical school researchers.

“Overall, we think these findings indicate that one way to reduce the appeal of e-cigarettes to youth and educate youth about e-cigarette health risks is to regulate advertising for flavors,” said Kathleen Garrison, first author of the paper.

While tobacco cigarettes are subject to heavy restrictions, the U.S. government currently does not regulate e-cigarette advertisements. The Family Smoking Prevention and Tobacco Control Act, passed in 2009, bans the promotion of cigarette flavors other than menthol as well as the targeting of youth. Without similar restrictions on e-cigarette advertisements, manufacturers can promote appealing flavors without consequences.

Flavored e-cigarettes have caused additional concern within the scientific community, as a growing body of research suggests that these products encourage tobacco use among youth. A nationwide study showed that, during their first encounters with e-cigarettes, most youth smoked flavored ones. The Yale Tobacco Center of Regulatory Science additionally reported that the majority of Connecticut youth who had tried e-cigarettes were motivated by appealing flavors.

Prompted by this research, the Yale-based group set out to understand how the brain processes flavored e-cigarette advertisements.

The study used fMRI and eye-tracking data from 26 young adults, ranging from 18 to 25 years old, as they viewed advertisements for flavored e-cigarettes and unflavored cigarettes, as well as control images showing sweet, fruity and minty flavors without tobacco.

“Our fMRI experiment indicated that when [viewing] images of fruits and sweets on e-cigarette advertisements, a brain region involved in reward responded more strongly than when [viewing] only images of tobacco on e-cigarette advertisements,” Garrison said.

Eye-tracking data revealed that participants spent less time focusing on health warnings included in flavored e-cigarette advertisements depicting fruits and sweets, which consequently decreased participants’ ability to recall the warnings.

The study is the first to report a neural preference for flavored e-cigarette advertisements. It is also the first to show that e-cigarette advertisement techniques can affect communication of health warnings. Garrison called these findings problematic, considering many youth lack knowledge of the health risks associated with e-cigarette use.

Although their work contributes to our understanding of e-cigarette advertisement perception, the authors did acknowledge its limitations. Suchitra Krishnan-Sarin, senior author of the paper, said the results need to be replicated, while Garrison added that they need to conduct a separate but similar experiment with adolescents younger than 18, since they are more likely to begin using tobacco than older people are.

Despite their work’s limitations, the authors said their findings will guide future research.

“To prevent youth from using e-cigarettes, we need a more complete understanding of the multiple factors that influence a young person’s decision to use e-cigarettes, including the appeal of flavors and their knowledge of health risks,” Garrison said.

Meanwhile, the Yale Tobacco Center of Regulatory Science attempts to prevent youth e-cigarette use through outreach to local high schools, according to Krishnan-Sarin. The center has developed a curriculum that educates students, parents and teachers on the health risks associated with e-cigarettes.

The study was published on March 23 in the journal Drug and Alcohol Dependence.

Marisa Peryer | marisa.peryer@yale.edu