BACKGROUND AND OBJECTIVES:

Electronic nicotine delivery systems (ENDS) have become the most popular tobacco products among young people, yet ENDS marketing remains unregulated, and its effects on ENDS use behavior across age groups is poorly understood. In this study, using a longitudinal design, we examined how recall of ENDS marketing through 5 different channels predicted subsequent ENDS initiation up to 2.5 years later among youth (ages 12–17 years) and young adults (ages 18–29 years).

METHODS:

Data were drawn from 2 large cohort studies in Texas. The analysis included school-going youth (n = 2288) and college-going young adults (n = 2423) who reported never having used ENDS at baseline in 2014. Logistic regression was used to assess the influence of recalled ENDS marketing exposure via television (TV), radio or Internet radio, billboards, retail stores, and the Internet on subsequent ENDS initiation, with adjustment for these channels, baseline sociodemographics, other past-30-day tobacco use, sensation seeking, and peer ENDS use.

RESULTS:

Recall of retail store–based ENDS marketing at baseline was associated with significantly higher odds of subsequent ENDS initiation among youth (adjusted odds ratio [aOR] = 1.99; 95% confidence interval [CI]: 1.25–3.17) and young adults (aOR = 1.30; 95% CI: 1.05–1.61) up to 2.5 years later. Young adult initiation was also associated with recalled ENDS marketing on TV at baseline (aOR = 1.29; 95% CI: 1.03–1.63).

CONCLUSIONS:

Marketing of ENDS at retail stores predicts youth and young adult ENDS initiation, and marketing on TV predicts young adult initiation. Future research and regulation should be used to address the most influential marketing channels.

What’s Known on This Subject:

Electronic Nicotine Delivery Systems (ENDS) are the most popular tobacco products today among youth and young adults. Previous tobacco research has revealed that marketing significantly influences cigarette smoking, yet few studies to date have been used to longitudinally assess this relationship for ENDS.

What This Study Adds:

In this study, we examine the impact of ENDS marketing on youth and young adult ENDS initiation up to 2.5 years later, controlling for sociodemographics, various intrapersonal and interpersonal factors, and 5 channels of marketing exposure. Findings have implications for prevention.

Use of electronic nicotine delivery systems (ENDS) (also referred to as electronic cigarettes) by young people is a major public health concern. Use of ENDS among youth and young adults increased substantially in recent years,1 surpassing that of conventional cigarettes since 2014.2,3 In the 2018 National Youth Tobacco Survey, 4.9% of middle school students and 20.8% of high school students reported using ENDS in the past 30 days.4 Rates of use are also high among young adults,1,5 with 13.6% reporting use “every day,” “some days,” or “rarely.”1 Evidence indicates that industry marketing has substantial influence on young people’s use of conventional tobacco products.6 However, the impact of marketing on ENDS use remains underexplored. In the current study, we examined the prospective associations between ENDS marketing through 5 channels (television [TV], radio or Internet radio, billboards, retail stores, and Internet) and subsequent ENDS initiation up to 2.5 years later among both youth (ages 12–17 years at baseline) and young adults (ages 18–29 years at baseline).

A growing body of research indicates that ENDS are marketed heavily to youth7,9 and young adults.1,10,12 ENDS marketing and retailers also are highly prevalent near grade schools13 and college campuses,14 with 1 study revealing that 66.5% of campuses had a vape shop within 3 miles.14 Despite this evidence, the US Food and Drug Administration’s authority did not extend to ENDS until 2016, and marketing of ENDS remains unregulated.15 The implications of unrestricted advertising and promotion are clear: nearly 70% of youth16 and 88% of young adults17 recalled exposure to ENDS marketing in 2014 through at least 1 channel, including retail stores, Internet, TV and movies, and newspapers and magazines. These proportions have undoubtedly risen because the number of ENDS brands and users has continued to increase.4,18 

Authors of several cross-sectional studies have observed significant correlations between self-reported ENDS marketing exposure and ENDS use in youth13,19,21 and young adults,16,22,24 although many have used cumulative exposure measures rather than differentiating between channel types. More recently, authors of a few longitudinal studies have explored the association between ENDS marketing and subsequent use, providing stronger evidence for potential causality. Nicksic et al25 examined the impact of recalled exposure to ENDS marketing on TV, on radio, on billboards, in retail stores, and on the Internet on initiation and past-30-day use at the 6-month follow-up among Texas middle and high school students. After the authors controlled for other exposure channels and sociodemographics, recall of store-based marketing predicted ENDS initiation at follow-up, whereas recall of Internet-based exposure predicted current use but not initiation. Recalled exposure to marketing on TV, radio, and billboards was not significantly associated with initiation or current use. Camenga et al26 reported that recall of ENDS marketing on Facebook was associated with initiation at the 6-month follow-up among middle and high school students in Connecticut, whereas other channels (TV and radio, magazines, billboards, stores, and other social network sites) were not associated. Finally, Cruz et al27 found that recall of marketing online, in stores, and outdoors significantly predicted initiation 16 months later among 11th- and 12th-graders in California after controlling for sociodemographics and other tobacco use. However, the authors of this study relied on separate models for each exposure channel rather than including all channels in 1 model to assess their influence simultaneously and determine the unique impact of each on ENDS use.

Existing studies make important contributions to the limited literature on ENDS marketing, but a number of gaps remain. First, the shortage of longitudinal studies precludes causal inference regarding the impact of ENDS marketing on use. Second, authors of few studies have examined multiple channels of exposure simultaneously to assess their unique association with subsequent use compared with other channels of exposure. Finally, young adults have been largely overlooked in ENDS marketing research despite evidence that they have high rates of use and have been aggressively targeted by the tobacco industry.1,28 

With the current study, we extend existing research by examining the impact of recalled ENDS marketing exposure on subsequent ENDS initiation up to 2.5 years later among youth and young adults, representing the longest follow-up period described to date. We examined the unique influence of recalled exposure from 5 channels (TV, radio, billboards, retail stores, and Internet) in 2 Texas-based samples of youth (middle and high school students) and young adults (2-year vocational school and 4-year university students). Analyses include all 5 marketing channels in a single model to compare their relative and unique influence while controlling for important covariates that have previously been associated with youth and young adult ENDS use, including baseline sociodemographics, other tobacco use, sensation seeking, and peer ENDS use.5,29,32 

The Tobacco Center of Regulatory Science on Youth and Young Adults has 2 rapid-response longitudinal surveillance systems that are used to assess recall of tobacco marketing and tobacco use among school-going youth (ages 12–17 years at baseline) and young adults (ages 18–29 years at baseline). The 2 studies are being conducted in the 5 counties surrounding the 4 largest cities in Texas: Houston, Dallas-Fort Worth, San Antonio, and Austin. The Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS) includes students in sixth, eighth, and 10th grades at baseline (n = 3907; N = 461 069) from 79 middle and high schools who were recruited by using a complex multistage probability design.33 The Marketing and Promotions Across Colleges in Texas (M-PACT) project includes students (N = 5482) enrolled in 24 2- and 4-year colleges.34 After providing active informed consent, participants voluntarily completed 5 Web-based surveys every 6 months through the spring of 2017, and retention rates for both studies were >70% at the 2.5-year follow-up. For the purposes of this study, only participants who reported never using ENDS at baseline and who had complete data were included. Thus, data from 2288 TATAMS participants and 2423 M-PACT participants were included in the current study. Additional details about study methods are described elsewhere for TATAMS33 and M-PACT.34 

This study was approved by the Center for the Protection of Human Subjects at the University of Texas Health Science Center at Houston (HSC-SPH-13-0377) and Institutional Review Board at the University of Texas at Austin (2013-06-0034) and meets the ethical standard outlines in the Helsinki Declaration of 1975 as revised in 2000. Informed consent was obtained from all participants and from parents for those age <18 years.

Baseline Recall of ENDS Marketing

Baseline survey items were used to assess recalled exposure to ENDS marketing through 5 channels: TV, radio, billboards, retail stores, and Internet (see Supplemental Table 3 for items). Dichotomized Internet exposure (1 = exposed; 0 = unexposed) was derived from an item in which students were asked to check where they remember seeing marketing for ENDS. For all other channels, questions used to assess frequency of recalled exposure were recoded to dichotomous variables (1 = exposed; 0 = unexposed) for consistency across channels, similar to research conducted by Nicksic et al.25 For TV, radio or Internet radio, and billboards, students who recalled observing ENDS marketing “occasionally,” “frequently,” and “very frequently” were considered exposed; those who “never” or “rarely” recalled ENDS marketing or those who did not use the channel (M-PACT only) were considered unexposed. For retail stores, students who recalled observing ENDS marketing “some of the time,” “most of the time,” or “every time” were considered exposed. Those who did not visit any stores in the past month or those who did not recall ENDS marketing (“never/not that I remember”) were considered unexposed.

ENDS Initiation

The primary outcome variable was ENDS initiation, which was assessed at all 5 follow-up waves with the same item asking participants if they had ever used ENDS (see Supplemental Table 3 for item). ENDS never users who reported ever using ENDS in any of the subsequent 5 follow-up waves were considered ENDS initiators and assigned a score of 1. Those who confirmed never using ENDS at the 2.5-year follow-up (ie, wave 6) were considered noninitiators and were assigned a score of 0.

Baseline Covariates

Covariates assessed at baseline were sex (1 = male, 0 = female), race and/or ethnicity (1 = Hispanic, 2 = Non-Hispanic white or other race, and 3 = Non-Hispanic African American), current other tobacco use (0 = did not use cigarettes, cigars, hookahs, or smokeless tobacco in the past 30 days; 1 = used at least 1 other product on at least 1 day in the past 30 days), and peer ENDS use (number of close friends who use ENDS; scored 1 [none] to 5 [all]). Three additional baseline covariates were assessed that varied across the 2 samples. Sensation seeking was measured by using the 4-item Brief Sensation Seeking Scale 435 for both groups, but responses ranged on a 5-point scale for the TATAMS sample and on a 4-point scale for the M-PACT sample. Moreover, TATAMS included grade level (sixth, eighth, and 10th) as a covariate, whereas M-PACT included age and type of college (2- vs 4-year college) as covariates.

Because of the complex survey design of TATAMS, we applied sampling weights for all statistical analyses and adjusted for clustering within schools and for nonresponse bias, which allowed results to be generalized to the population of sixth, eighth, and 10th grade students in the sampled counties (see Pérez et al33). For M-PACT, multilevel analyses were used to accommodate the clustering of participants in college by including college in each model as a random effect. All analyses were performed by using Stata 15.36 

Logistic regression analyses were used to determine if baseline recall of ENDS marketing predicted subsequent ENDS initiation up to 2.5 years later. Separate models were examined for the youth and young adult samples, and only participants reporting never using ENDS at baseline were included. Models included all 5 types of recalled marketing exposure (TV, radio or Internet radio, billboards, retail stores, and Internet) as independent variables to control for the other types of exposure and were additionally adjusted for baseline covariates of sex, race and/or ethnicity, grade level (TATAMS only), age and college type (M-PACT only), current other tobacco use, sensation seeking, and peer ENDS use.

Data from 2288 youth who reported never using ENDS at baseline were included in analyses; an additional 926 youth were excluded because of missing data. Data from 2423 young adults who reported never using ENDS at baseline were also included in analyses; an additional 423 young adults were excluded because of missing data. χ2 and t tests were conducted to determine differences on all baseline variables between those included and those excluded. For youth, results indicated there were differences between the 2 groups on 4 of 11 study variables: excluded youth were more likely to be in sixth or eighth grade compared with 10th grade, were more likely to be Hispanic or African American, and were less likely to recall ENDS marketing exposure in retail stores or on the Internet. For young adults, there were group differences for 3 of 12 variables: excluded young adults were more likely to be Hispanic or African American, were more likely to be enrolled in 2-year compared with 4-year colleges, and were more likely to recall exposure to ENDS marketing on billboards.

Youth

Of the 2288 youth who reported never using ENDS at baseline, ∼14% (weighted percentage; n = 359) initiated ENDS use during the 2.5-year follow-up period. As shown in Table 1, ∼50% of the sample were girls, and more than half identified as Hispanic. Sixth- and eighth-graders each composed more than one-third of ENDS never users, with 28% in 10th grade at baseline. Only baseline ENDS marketing at retail stores was recalled by a majority of the sample (58%), whereas all other forms of marketing exposure were recalled by less than half. Only 1.2% of the sample reported current use of other tobacco products at baseline.

TABLE 1

Descriptive Statistics for Baseline Recall of ENDS Marketing and Covariates Among Youth and Young Adults Who Reported Never Using ENDS at Baseline

Baseline VariablesYouth (TATAMS) (n = 2288)a,bYoung Adults (M-PACT) (n = 2423)
Recall of ENDS marketing, %   
 TV 43.8 28.9 
 Radio or online radio 21.2 25.6 
 Billboards 38.9 26.6 
 Retail stores 57.6 56.4 
 Internet 42.9 56.9 
Female sex, % 49.4 66.7 
Race and/or ethnicity, %   
 Hispanic 53.2 27.6 
 Non-Hispanic white or other 30.6 64.2 
 Non-Hispanic African American 16.1 8.2 
Grade level, %   
 Sixth 36.3 — 
 Eighth 35.6 — 
 10th 28.2 — 
Age, mean (SD) — 20.3 (2.18) 
College type, %   
 2-y — 6.8 
 4-y — 93.2 
Current other tobacco use, % 1.2 10.8 
Sensation seeking, mean (SD)c 2.8 (1.10) 2.6 (0.65) 
Peer ENDS use, mean (SD)d 1.3 (0.71) 1.6 (0.75) 
Baseline VariablesYouth (TATAMS) (n = 2288)a,bYoung Adults (M-PACT) (n = 2423)
Recall of ENDS marketing, %   
 TV 43.8 28.9 
 Radio or online radio 21.2 25.6 
 Billboards 38.9 26.6 
 Retail stores 57.6 56.4 
 Internet 42.9 56.9 
Female sex, % 49.4 66.7 
Race and/or ethnicity, %   
 Hispanic 53.2 27.6 
 Non-Hispanic white or other 30.6 64.2 
 Non-Hispanic African American 16.1 8.2 
Grade level, %   
 Sixth 36.3 — 
 Eighth 35.6 — 
 10th 28.2 — 
Age, mean (SD) — 20.3 (2.18) 
College type, %   
 2-y — 6.8 
 4-y — 93.2 
Current other tobacco use, % 1.2 10.8 
Sensation seeking, mean (SD)c 2.8 (1.10) 2.6 (0.65) 
Peer ENDS use, mean (SD)d 1.3 (0.71) 1.6 (0.75) 

—, not applicable.

a

Weighted percentages are presented because of the complex sampling design of TATAMS.

b

This sample generalizes back to a population of 357 949 youth in the 4 cities in 5 counties where youth were sampled for this study.

c

Scored on a scale from 1 (strongly disagree) to 5 (strongly agree) for the youth (TATAMS) sample and from 1 (strongly disagree) to 4 (strongly agree) for the young adult (M-PACT) sample.

d

Question asked about ENDS use of a close friend were scored on a scale from 1 (none) to 5 (all) for both samples.

Young Adults

Of the 2423 young adults who reported never using ENDS at baseline, 25% (n = 611) initiated ENDS use during the 2.5-year follow-up period. As shown in Table 1, 67% of the sample were women; 64% identified as non-Hispanic white or other, and just more than one-quarter identified as Hispanic. At baseline, participants were, on average, 20.3 years old, and most were enrolled in a 4- vs 2-year college. A majority of the sample recalled ENDS marketing at retail stores and on the Internet at baseline (∼56%), whereas <30% recalled all other forms of exposure. Approximately 11% of the sample reported current use of other tobacco products at baseline.

Youth

Baseline recall of ENDS marketing exposure in retail stores was the only significant marketing predictor of subsequent ENDS initiation up to 2.5 years later. Recall of marketing in retail stores was significant even after controlling for the significant effects of the following covariates: race and/or ethnicity, grade level, and peer ENDS use. Youth who recalled ENDS marketing at retail stores had 1.99 times higher odds of ENDS initiation up to 2.5 years later compared with those who did not recall store-based marketing (see Table 2).

TABLE 2

Associations Between Baseline Recall of Exposure to ENDS Marketing and ENDS Initiation Up to 2.5 Years Later Among Youth and Young Adults Who Reported Never Using ENDS at Baseline, Adjusted for Covariates

Youth (TATAMS) InitiationaYoung Adults (M-PACT) Initiationb
Adjusted OR (95% CI) (n = 2288)cAdjusted OR (95% CI) (n = 2423)
TV 1.08 (0.77–1.53) 1.29 (1.03–1.63)* 
Radio or online radio 1.24 (0.76–2.01) 0.99 (0.77–1.27) 
Billboards 1.30 (0.89–1.91) 1.10 (0.87–1.41) 
Retail stores 1.99 (1.25–3.17)* 1.30 (1.05–1.61)* 
Internet 0.85 (0.61–1.18) 1.20 (0.97–1.48) 
Youth (TATAMS) InitiationaYoung Adults (M-PACT) Initiationb
Adjusted OR (95% CI) (n = 2288)cAdjusted OR (95% CI) (n = 2423)
TV 1.08 (0.77–1.53) 1.29 (1.03–1.63)* 
Radio or online radio 1.24 (0.76–2.01) 0.99 (0.77–1.27) 
Billboards 1.30 (0.89–1.91) 1.10 (0.87–1.41) 
Retail stores 1.99 (1.25–3.17)* 1.30 (1.05–1.61)* 
Internet 0.85 (0.61–1.18) 1.20 (0.97–1.48) 

CI, confidence interval; OR, odds ratio.

a

Adjusted for baseline sex, race and/or ethnicity, grade level, past-30-day or current other tobacco use, sensation seeking, and peer ENDS use. The following were significant: race and/or ethnicity (white or other race versus African American [OR = 2.13; 95% CI: 1.33–3.41]; white or other race versus Hispanic [OR = 1.38; 95% CI: 1.03–1.86]), grade level (eighth versus sixth grade [OR = 2.19; 95% CI: 1.04–4.61]; 10th versus sixth grade [OR = 2.34; 95% CI: 1.05–5.19]), and ENDS use of a close peer [OR = 1.51; 95% CI: 1.14–1.99]).

b

Adjusted for baseline sex, race and/or ethnicity, age, college type, current other tobacco use, sensation seeking, and peer ENDS use. The following were significant: current other tobacco use (OR = 5.64; 95% CI: 4.24–7.49), sensation seeking (OR = 1.37; 95% CI: 1.17–1.60), and ENDS use of a close peer (OR = 1.37; 95% CI: 1.21–1.56).

c

This sample generalizes back to a population of 357 949 youth in the 4 cities in 5 counties where youth were sampled for this study.

*

P < .05.

Young Adults

Baseline recall of ENDS marketing exposure in retail stores significantly increased the odds of subsequent ENDS initiation up to 2.5 years later, with odds of initiation 1.30 times higher for young adults who recalled store-based ENDS marketing compare with those who did not. Additionally, recall of ENDS marketing on TV significantly increased odds of subsequent ENDS initiation, with odds of initiation 1.29 times higher for those who recalled marketing on TV compared with those who did not. These effects were significant even after controlling for the significant effects of current other tobacco use, sensation seeking, and peer ENDS use (see Table 2).

Findings reveal that recalled exposure to ENDS marketing at retail stores makes a unique contribution to ENDS initiation up to 2.5 years later for both youth and young adults. For young adults, ENDS marketing on TV also uniquely contributes to ENDS initiation. It is notable that recall of these marketing exposures was significant even after we controlled for important covariates, including other tobacco use, sensation seeking, and peer ENDS use. These findings build on a small body of evidence that reveals a temporal link between self-reported ENDS marketing and use25,27,37 similar to that observed for other tobacco products.6 

Results reveal the importance of examining marketing channels individually rather than cumulatively because different marketing channels have varying influences on behavior. Understanding how and why these differences exist remains a critical question because characteristics, such as content, opportunities for user engagement, and placement, may affect how marketing channels influence behavior.1 Drawing on the elaboration likelihood model, 1 mechanism of influence may be the degree to which viewers actively engage with marketing (influence via the “central route”) versus passively absorbing (“peripheral route”).38,39 Although marketing on TV, in magazines, on radio, and on billboards tends to be passively observed, retail stores and the Internet provide both cues and opportunities for immediate response. For example, retail stores often display marketing near checkout counters, simultaneously marketing ENDS products and providing direct access to them.40 Notably, the use of self-reported measures of marketing exposure in this study likely means that findings most closely reflect the influence of central-route exposure on behavior because to actively recall seeing ENDS marketing reveals conscious recognition of its presence. Different odds ratios by channel therefore reflect not only marketing dosage and content but also the likelihood that young people who have never used ENDS consciously register and engage with those channels.

With this study, we extend existing research by examining the impact of ENDS marketing on both youth and young adults. Both are important developmental periods, but research on young adults is generally lacking. Although the results presented here reflect 2 distinct study samples and cannot be directly compared, observable differences suggest the importance of considering these 2 groups separately and of investigating ENDS-use trajectories across the transition to adulthood. Recall of ENDS marketing at retail stores predicted ENDS initiation among both groups, but ENDS marketing on TV predicted only young adult initiation, although more youth appeared to recall ENDS marketing on TV (43.8%) compared with young adults (28.9%). Although it is not clear why recall of TV marketing predicted only young adult initiation, 1 possibility lies in the content of TV advertisements and their appeal (or lack thereof) to youth. Previous research used to examine ENDS advertisements appearing on TV and/or social media between 2009 and 2014 revealed that a large proportion contained messages that are not typically appealing to youth, such as messages that are critical of cigarettes, that compare ENDS use with cigarette use, and/or that describe health effects.7 However, given the lack of research examining the impact of advertisements through various channels on ENDS-use behaviors across developmental levels, more research that tracks youth and young adults across time is needed. Continued surveillance is important because industry marketing and participant exposure and engagement may change over time. Results from a prospective national study of 12- to 17-year-old adolescents reveal that engagement with online tobacco and ENDS marketing increased from 8.7% in 2013–2014 to 20.9% in 2014–2015.41 It is likely that engagement will continue to rise because the prevalence of using both ENDS and social media has continued to rise.3,42 

The current study fills an important gap in the literature regarding ENDS marketing and subsequent ENDS initiation. However, there are limitations. Data are specific to Texas and may not be generalizable to the larger population. Reliance on self-reported data is also a limitation. Although some research reveals a moderate correlation between recalled exposure and objective proxy measures,43 self-reports introduce potential for reporting biases. For example, recall of ENDS marketing on TV and the Internet may capture informational content (eg, news stories or blogs)44 and not just advertisements and promotions for ENDS. However, self-report likely reflects primarily conscious exposure (ie, central-route exposure in the elaboration likelihood model), and findings have unique implications in this context. An important direction for future research is using objective exposure measures to study the influence of marketing on behavior. Finally, although initiation is 1 of the first stages in a progression of tobacco- and/or nicotine-product use behaviors, it is not possible to determine who will become a regular user. Additional longitudinal research is needed to determine the role of ENDS marketing exposure on subsequent stages of youth and young adult ENDS use as they unfold.

Recall of ENDS marketing exposure in retail stores uniquely predicts youth and young adult ENDS initiation, and recall of marketing on TV predicts young adult initiation. These findings underscore the need for regulation of ENDS marketing, particularly in retail stores. An important regulatory consideration for the US Food and Drug Administration includes reducing the size, visibility, and availability of ENDS advertisements and products in retail stores. A consideration for state and local governments is restricting price promotions, discounts, and coupons that are prevalent in the retail environment45 given that young people are more likely to purchase tobacco and/or nicotine products as the prices decrease.46 Finally, state governments can consider entering into assurances of voluntary compliance with retailers who sell ENDS products to further limit the type and placement of advertisements in their retail stores.47 Given the increasing popularity of ENDS products among young people, limiting ENDS marketing in retail stores is of paramount importance.

Dr Loukas conceptualized and designed the study, supervised the drafting of the initial manuscript, led the revision of the manuscript, led the longitudinal study of young adults, and designed the data collection instruments for it; Ms Paddock drafted the initial manuscript and conducted initial analyses for the youth study sample; Dr Li drafted sections of the manuscript, led the analysis for the young adult study sample, conducted analyses for the youth study sample, and participated in the revision process; Dr Harrell conceptualized and designed the study, critically reviewed the manuscript, led the longitudinal study of youth, and designed the data collection instruments for it; Dr Pasch contributed to the study measures and critically reviewed the manuscript; Dr Perry contributed to the design of the larger cohort studies and critically reviewed the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

FUNDING: Supported by the National Institutes of Health (1 P50 CA180906) from the National Cancer Institute and the US Food and Drug Administration Center for Tobacco Products. Support for Dr Li was also provided by the National Institute on Alcohol Abuse and Alcoholism (R01 AA019511). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the US Food and Drug Administration. Funded by the National Institutes of Health (NIH).

     
  • ENDS

    electronic nicotine delivery system

  •  
  • M-PACT

    Marketing and Promotions Across Colleges in Texas

  •  
  • TATAMS

    Texas Adolescent Tobacco and Marketing Surveillance System

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Competing Interests

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

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