When it comes to marketing electronic cigarettes to young people, fake news appears to stick.
The U.S. Food and Drug Administration currently requires a prominent warning about the dangers of nicotine for e-cigarettes. But just before that mandate, a 2017 campaign by e-cigarette maker blu included fake warnings in precisely the place the real warnings would eventually appear.
Messages such as "IMPORTANT: Contains flavor" and "IMPORTANT: Less harmful to your wallet" appeared atop the ads in large print inside a box, mimicking the format of the then-upcoming federally mandated message -- "WARNING: This product contains nicotine. Nicotine is an addictive chemical."
Legitimate warnings appeared in smaller print at the bottom of the 2017 ads.
When adolescent boys viewed fake-warning ads, those marketing messages stuck with them, according to the new study, which appears in the journal Tobacco Control and was led by Brittney Keller-Hamilton of The Ohio State University.
"On top of leaving an impression on these boys, these fake warnings seem to desensitize the boys to the actual health warnings that appeared less prominently at the bottom of these ads," said Keller-Hamilton, epidemiology doctoral student and program manager for Ohio State's Center of Excellence in Regulatory Tobacco Science.
The research included 775 boys between 12 and 19 years old who were randomly assigned to view real e-cigarette ads with or without a fake warning. Researchers asked the boys what they remembered most about the advertisements -- which appeared in magazines likely to appeal to them, such as Sports Illustrated. Boys in the study were part of the Ohio-based Buckeye Teen Health Study.
The researchers were in the midst of that larger study when the blu fake warnings ads began to appear in magazines, Keller-Hamilton said.
"We just couldn't believe this and we wondered what impression these ads were leaving on these kids, who we already know are at a particularly vulnerable age when it comes to tobacco marketing," she said.
Of those who viewed the fake-warning blu ads that were part of its "Something Better" campaign, 27 percent of the participants said that positive "warning" was the most memorable part of the ad, and about 19 percent of them were able to repeat what it said.
Those same boys had lower odds of recalling actual warnings about health risks than boys who looked at other e-cigarette ads with the real warnings. All of the advertising carried smaller warning language at the bottom of the ad.
Though this particular advertising ploy can't be duplicated for e-cigarettes under current U.S. law, the study illustrates the power of tobacco marketing on young people and could serve to inform policy changes governing other products, including combustible cigarettes, said Keller-Hamilton.
"There's nothing stopping tobacco marketers from trying a similar strategy, and the FDA could consider putting something in place to stop this type of advertising going forward," said Amy Ferketich, the study's senior author and an Ohio State professor of epidemiology.
"The tobacco industry has a very long history of trying to lure in adolescents," she said. "This shows another way in which young people are particularly susceptible to tobacco marketing strategies."
Other researchers from Ohio State who worked on the study were Megan Roberts, Michael Slater and Micah Berman.
The National Cancer Institute and the FDA's Center for Tobacco Products supported this research.
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