E i tt d S ki iE-cigarettes and Smoking in Young People: Findings fromYoung People: Findings from DISPLAY study

Catherine Best & Sally HawFaculty of Health Sciences & SportFaculty of Health Sciences & SportUniversity of Stirling

DISPLAY Study: Impact of Ban of POS Tobacco MarketingDISPLAY Study: Impact of Ban of POS Tobacco Marketing

1. Mapping Study 2. Marketing audit

3. School Survey 4. Focus groups

E-cigarette Use & Cigarette Brand AwarenessE cigarette Use & Cigarette Brand Awareness • Young people who were aware of more cigarette brands

were more likely to have tried an e cigarettewere more likely to have tried an e-cigarette.• This was the case even when the young person’s

smoking status was included in the analysissmoking status was included in the analysis• Young people who were aware of more cigarette brands

were also more likely to intend to try an e-cig in the nextwere also more likely to intend to try an e cig in the next 6 months

• Tobacco retail outlet density and time spent hanging y p g garound in the street were also significant predictors

Best C, van der Sluijs W, Haseen F, Eadie D, Stead M, MacKintosh AM, et al. (2016) Does , j , , , , , ( )exposure to cigarette brands increase the likelihood of adolescent e-cigarette use? A cross-sectional study. BMJ Open 2016;6(2):e008734.

E cigarette ExperienceE-cigarette Experience• Young people who recalled seeing e-cigarettes for

l i ll h lik l t h t i dsale in small shops more likely to have tried an e-cigarette

• Young people who saw e-cigarettes on the internet also more likely to have used them.

• Young people who recalled seeing e-cigarettes for sale in small shops and in supermarkets more p plikely to intend to try them in the next 6 months.

Best C, Haseen F, van der Sluijs W, Ozakinci G, Currie D, Eadie D, et al. Relationship between est C, asee , a de S u js , O a c G, Cu e , ad e , et a e at o s p bet eee-cigarette point of sale recall and e-cigarette use in secondary school children: a cross-sectional study. BMC Public Health 2016 16(1):310.

DISPLAY- Longitudinal Trends in Ever e-cigarette Use and Smoking10

060

80

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406

% tr

ied

e-ci

ga

20

%

0

2013 2014 2015 2016Year

Never smoker Ex smoker Smoked once or twice Current smoker

Number of Young People Tried an E-cig by Smoking Status20

015

0

ciga

rette

100

ber t

ried

e-c

50Num

b

0

2013 2014 2015 2016YearYear

Never smoker Ex smoker Smoked once or twice Current smoker

E-cigarette Use and Smoking Uptake in Baseline ‘Never Smokers’Have you ever smoked cigarettes or roll-ups, even if it is just one or two puffs? 2016

Total

No YesE-cig use 2015

I have never used an e-cigarette

1689 250 1939

87.1% 12.9% 100.0%2015

I have only used them once or twice

104 64 168

61.9% 38.1% 100.0%

I th ti 3 5 8I use them sometimes (monthly)

3 5 8

37.5% 62.5% 100.0%

I use them often (weekly) 2 4 6( y)

33.3% 66.7% 100.0%

Total 1798 323 2121

84.8% 15.2% 100.0%

Smoking by 2016 Odds ratio p 95% CI

E-cig use at 2015 4.11 <0.001 3.13-5.40Susceptible to 4.98 <0.001 3.93-6.31psmokingAge 1.21 <0.001 1.11-1.31S 1 16 0 214 0 92 1 45Sex 1.16 0.214 0.92-1.45Family affluencescale (FAS) low

1

FAS medium 1.13 0.400 0.85-1.50FAS high 0.99 0.924 0.74-1.31S 1 1 3 0 0 6 0 99 1 88School 1 1.37 0.056 0.99-1.882 13 1 58 0 005 1 15-2 173 1.58 0.005 1.15 2.174 1.77 0.001 1.25-2.52Ethnic group 1.16 0.535 0.73-1.82

Summary of DISPLAY FindingsSummary of DISPLAY Findings

• We found:– Cross sectional relationship between tobacco brand

awareness and e-cigarette use in young peopleC ti l l ti hi b t ll f– Cross sectional relationship between recall of e-cigarette at point of sale in shops and e-cigarette use Among never smokers longitudinal relationship– Among never smokers, longitudinal relationship between baseline e-cig use and having tried smoking by 1yr follow upby 1yr follow up

Early DaysEarly Days

• Early stage in the development of e-cigarettesUnderstanding of patterns of use limitedEvolving technologyEvolving channels of communication

Policy makers have to make decisions based on incomplete• Policy makers have to make decisions based on incomplete and sometimes contradictory evidence.

• Future role of e-cigarettes in smoking cessation or as life style g g ychoice is unpredictable

• There is a tension between promotion of e-cigarettes as a cessation aid and protection of the next generationcessation aid and protection of the next generation.

Demand for E-cigs Driven by MarketingDemand for E cigs Driven by Marketing

New Advertising Opportunities at Point of SaleNew Advertising Opportunities at Point of Sale

JTI Launch New Combined Tobacco & E-cigarette GantryJTI Launch New Combined Tobacco & E-cigarette Gantry

Vaping Stores Provide Tailored Advice to Smokers

E cigarette Regulation required by EU revised TPDE-cigarette Regulation required by EU revised TPD

• UK Standardised Packaging of Tobacco ProductsUK Standardised Packaging of Tobacco Products Regulations (2015)

Advertising ban on television radio newspapers and inAdvertising ban on television, radio, newspapers and in most magazines bannedIndividual jurisdictions have discretion to ban atIndividual jurisdictions have discretion to ban at POS and on bill boards Health warning “Nicotine is addictive”gAge restricted productRefill size limitRefill size limit

Tobacco industry response to e cigaretteTobacco industry response to e-cigarette advertising restrictions

• "Certain media in certain markets are going to be cut off to us We• Certain media in certain markets are going to be cut off to us. We acknowledge and respect that. But our vision is that ‘Just You & Blu’ is a long-term campaign, so we’re looking for other ways to bring it to life.“

• "We need to let consumers know what is in e-cigarettes, that they’re less g yharmful than cigarettes, and the science behind it."

• Social-media platforms of vaping brands – which can continue to operate – will be key to communicating this message. "I t d f th i b bl t t k ti t l• "In any category, word of mouth is probably your strongest marketing tool but that’s probably even more pronounced in ours."

John Wardley Fontem Ventures (Imperial Tobacco subsidiary)John Wardley, Fontem Ventures (Imperial Tobacco subsidiary)http://www.campaignlive.co.uk/article/1393524/eu-clampdown-will-reshape-e-cigarette-

marketing#erH0Jbk5tOcSdL31.99

Growing importance of role of POSGrowing importance of role of POSfPOS• "With e cigarettes seen as one of the growth areas for the• With e-cigarettes seen as one of the growth areas for the

tobacco industry, these restrictions will mean in-store communication will take on significant importance in g pdriving this growth,"

• "Brands will want to consider the channel, the shopper and the shopper mission, then ensure strength in the communication: does it grab my attention? Is it clear why thi b d i b tt th th ?"this brand is better than another?"

Sarah Green, Chief Executive, Grey Shopperhttp://www campaignlive co uk/article/1393524/eu clampdown will reshape e cigarettehttp://www.campaignlive.co.uk/article/1393524/eu-clampdown-will-reshape-e-cigarette-

marketing#erH0Jbk5tOcSdL31.99

Social Media & POSSocial Media & POS• Social media and word of mouth continue to play

significant rolesignificant role.• POS will play an increasingly important role but may be

interpreted differently by different groupsinterpreted differently by different groupsCessation/smoking reduction aidFor use where smoking prohibitedLifestyle choice

• Scottish Government does plan to ban bill board advertising but not restrict POS

• Challenge to maximise benefits and minimise harms

POS Policy Options Policy Option Pros Cons

Develop E-cigarette Register Facilitates monitoring of market and further research

Resource intensive because of diversity of retail outlets

Promote e-cigs at POS only as aharm reduction/ cessation aid

Targets smokers Not feasible as only one product currently licensed by MHRA and evidence still inconclusive

Shutter e-cigarette Displays Easy to enforce. Reduces young Could reduce access to e-cigarettespeoples exposure to POS marketing messages promoting a lifestyle product

among smokers who want to quit.

Restrict marketing at point of sale Might reduce exposure Not clear what types of marketing i ht b t b t i t d Diffi lt tmight best be restricted. Difficult to

enforce

Introduce plain packaging for e-cigs

Disrupts development of branding and promotion as a lifestyle product. Maintains availability to smokers Easy

Long time to develop agreements and implement unless current tobacco plain packagingMaintains availability to smokers. Easy

to enforce.tobacco plain packaging regulations could be extended to e-cigarettes

Require e-cigarettes to be displayed at certain distance from

Reduces young people’s exposure.Maintains availability to smokers but

Reduces access by smokers. Potential for theftdisplayed at certain distance from

cigarettes and tillMaintains availability to smokers butdisrupts the development of association between e-cigs and smoking in young people

Potential for theft

DISPLAY Project teamDISPLAY Project team& Acknowledgements• Sally Haw (PI), Martine Stead, Douglas Eadie, Anne Marie

MacKintosh Catherine Best Susan Murray: University ofMacKintosh, Catherine Best, Susan Murray: University of Stirling

• Andy MacGregor Susan McConville: ScotCenAndy MacGregor, Susan McConville: ScotCen• Amanda Amos, Jamie Pearce, John Frank, Catherine

Tisch: University of Edinburghy g• Dorothy Currie, Gozde Ozakinci, Farhana Haseen:

University of St Andrewsy• Funded by NIHR PHR