Abstract
INTRODUCTION: E-cigarette use among young adults is strongly influenced by marketing strategies. Given the U.S. Food and Drug Administration's authority to regulate E-cigarette marketing, this study identified which advertisements and specific features are most appealing to young adults to inform potential regulatory action. STUDY DESIGN: Using a within-subjects laboratory design, participants viewed 15 print E-cigarette advertisements from 3 brands (Blu, Juul, and MarkTen), each featuring combinations of people, descriptors, branding, and warnings during 2021-2022. SETTING/PARTICIPANTS: Young adults (N=62; aged 18-26 years) who were susceptible to but not current E-cigarette users completed the study. While viewing advertisements, heart rate (attention) and eye tracking (visual attention) were continuously recorded. After each advertisement, participants rated perceived risk and motivation to avoid E-cigarettes. INTERVENTION: All participants completed the same advertisement-viewing task. Self-reported message perceptions and psychophysiological indicators of cognition and emotion were collected. Data were integrated using a multiattribute decision-making framework to identify advertisements with the highest overall appeal. MAIN OUTCOME MEASURES: Primary outcomes included perceived risk, motivation to avoid, heart rate deceleration, visual attention, and recognition accuracy. RESULTS: Data were analyzed from 2022 to 2025. Participants spent more time viewing descriptors and people than brand logos or warnings (p<0.001). Integrated rankings identified 2 Blu advertisements and 1 Juul advertisement as most appealing. CONCLUSIONS: People and descriptive language captured the most attention in E-cigarette advertisements. Limiting testimonials, switching language, and restricting advertisements to branding-only formats may reduce appeal among young adults and help prevent initiation.