7 in 10 Teens Exposed to E-Cigarette Ads, CDC Finds

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Public health officials are worried about the increased popularity of e-cigarettes because they could be a gateway to the use of combustible tobacco products.

In 2014, nearly 7 in 10 middle and high school students, or 18.3 million youth, were exposed to advertisements for e-cigarettes from at least one source, according to CDC data released today.

Retail stores accounted for half these exposures (52.8%) followed by the Internet (35.8%) and TV and movies (34.1%). At least 32% of students in both middle and high school said they were exposed to e-cigarette ads from more than one source. The data were released in CDC’s Mortality and Morbidity Weekly Report, in an edition of “Vital Signs” led by Tushar Singh, MD.

Public health officials track exposure to e-cigarette advertising because it might contribute to the use of e-cigarettes among youth, which in turn could lead teens to use tobacco products, either during their high school years or as adults.


While e-cigarettes have been promoted by their manufacturers as a safer alternative than tobacco or perhaps as a tool to help people quit cigarettes, health officials fear that for teens, the product path will flow the other way. According to CDC, e-cigarette use has increased from 0.6% to 3.9% among middle schoolers and from 1.5% to 13.4% among high schoolers from 2011 to 2014, a leap that alarms public health officials who have been years trying to curb tobacco use.

Among middle school students 66.4% were exposed to e-cigarette ads from at least one source, with retail stores being the most common place (52.8%). In order, the other sources were the Internet (35.8%), movies and TV, (34.1%), and newspapers and magazines (25%). More girls saw ads than boys, and exposure in stores was higher among white children than black children. Black children were more likely to see ads on TV.

At the high school level, 70.9% reported seeing at least one ad, with 56.3% seeing at least one in a retail store, followed by the Internet (42.9%), TV and movies (38.4%), and newspapers and magazines (34.6%). As with middle schoolers, exposure for whites was higher in retail stores, while exposure for black children was higher from TV and movies.

The authors called for “comprehensive efforts” to limit youth exposure to e-cigarette ads, because this kind of advertising is critical for manufacturers to encourage experimentation and use among youth. The rise of the Internet and its place in the advertising arsenal are highly problematic, because one study of 57 online vendors found that 70.2% used more than one social media network to market e-cigarettes, but 35.1% had no detectable age verification process.

“Adding e-cigarettes and other tobacco products to the list of current tobacco products prohibited from being sent through the US mail and requiring age verification for online sales at purchase and delivery could also prevent sales to youths,” they wrote.

Comprehensive education and prevention efforts are needed to keep youth away from e-cigarettes, the authors wrote, however, “In 2015, states used only 1.9%, or $490.4 million or combined revenues of $25.6 billion from settlement payments and tobacco taxes on comprehensive tobacco control programs.”


Singh T, Marynak K, Arrazola RA, et al. Vital signs: exposure to electronic cigarette advertising among middle school and high school students—United States, 2014. MMWR. 2016;64 [January 5, 2016.]