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E-cigarette adverts and children’s perceptions of tobacco smoking harms: an experimental study and meta-analysis
  1. Milica Vasiljevic1,
  2. Amelia St John Wallis1,
  3. Saphsa Codling1,
  4. Dominique-Laurent Couturier1,
  5. Stephen Sutton1,2,
  6. Theresa M Marteau1
  1. 1 Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
  2. 2 Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Milica Vasiljevic; milica.vasiljevic{at}


Objectives Children exposed to electronic cigarette (e-cigarette) adverts may perceive occasional tobacco smoking as less harmful than children not exposed to e-cigarette adverts. Given the potential cross-cueing effects of e-cigarette adverts on tobacco smoking, there is an urgent need to establish whether the effect found in prior research is robust and replicable using a larger sample and a stronger control condition.

Design A between-subjects experiment with one independent factor of two levels corresponding to the advertisements to which participants were exposed: glamorous adverts for e-cigarettes, or adverts for objects unrelated to smoking or vaping.

Participants English school children aged 11–16 (n=1449).

Outcomes Perceived harm of occasional smoking of one or two tobacco cigarettes was the primary outcome. Secondary outcomes included: perceived harm of regular tobacco smoking, susceptibility to tobacco smoking and perceived prevalence of tobacco smoking in young people. Perceptions of using e-cigarettes were gauged by adapting all the outcome measures used to assess perceptions of tobacco smoking.

Results Tobacco smokers and e-cigarette users were excluded from analyses (final sample n=1057). Children exposed to glamorous e-cigarette adverts perceived the harms of occasional smoking of one or two tobacco cigarettes to be lower than those in the control group (Z=−2.13, p=0.033). An updated meta-analysis comprising three studies with 1935 children confirmed that exposure to different types of e-cigarette adverts (glamorous, healthful, flavoured, non-flavoured) lowers the perceived harm of occasional smoking of one or two tobacco cigarettes (Z=3.21, p=0.001).

Conclusions This study adds to existing evidence that exposure to e-cigarette adverts reduces children’s perceptions of the harm of occasional tobacco smoking.

  • preventive medicine
  • public health
  • priority populations
  • electronic cigarettes
  • e-cigarette marketing
  • tobacco smoking

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  • Contributors MV supervised the study and oversaw the acquisition of data. MV and D-LC were responsible for the data analysis. MV drafted the manuscript. ASW, SC, D-LC, SS and TMM provided critical revisions to the manuscript. All authors collaborated in designing the study, contributed to the interpretation of results and read and approved the final version of the manuscript.

  • Funding This report is an independent research commissioned and funded by the National Institute for Health Research Policy Research Programme (Policy Research Unit in Behaviour and Health (PR-UN-0409-10109)).

  • Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or its arm’s-length bodies and other government departments. The final version of the report and ultimate decision to submit for publication was determined by the authors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval University of Cambridge’s Psychology Research Ethics Committee [PRE.2015.106].

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement We are willing to make all data available to any interested parties. Please contact the corresponding author for more information.

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