Abstract
INTRODUCTION: Although e-cigarette retail marketing correlates with adolescent and young adult (AYA) e-cigarette use, little is known about whether AYAs' likelihood of purchasing e-cigarettes increases with specific retail marketing exposure and increased marketing receptivity. METHODS: We conducted an online cross-sectional survey (n = 5326) among US 13-24 year-olds (December 2023-March 2024). Participants self-reported their likelihood of purchasing e-cigarettes based on 12 mock photographs showing hypothetical advertising locations and 16 product display locations in the retail environment. Age-stratified logistic regression (13-20y vs. 21-24y) examined relationships between e-cigarette retail marketing receptivity and e-cigarette purchase from a retail store, susceptibility to use, and past-30-day use, adjusting for covariates. RESULTS: Among hypothetical advertising locations, advertisements on store doors/windows (13.3%) and near checkout (15.4%) made participants most likely to want to purchase e-cigarettes. Among product display locations, 13-20y were more likely than 21-24y to want to purchase e-cigarettes if unlocked at the checkout counter and next to snacks/candy (p < .001). One in six 13-20y reported receiving a free sample in a retail store. Retail marketing receptivity significantly increased the odds of susceptibility to use (13-20y: 2.1[1.7, 2.5]; 21-24y: 2.0[1.3, 3.1]) and past-30-day use (13-20y: 3.0[2.5, 3.7]; 21-24y: 4.5[3.6, 5.6] and was associated with having purchased an e-cigarette (13-20y: 1.4[1.0, 1.8]; 21-24y:n.s.). CONCLUSIONS: AYAs report they are more likely to purchase and use e-cigarettes when exposed to and receptive to e-cigarette retail marketing, particularly when products are easily accessible (unlocked, near checkout) and advertised prominently (store exterior, near checkout). Policy and awareness efforts to reduce the impact of advertising, displays, and free samples are needed for those <21 years. IMPLICATIONS: This study provides new evidence that AYAs are likely to want to purchase e-cigarettes from retail stores when the products are easily accessible (unlocked, near checkout) and advertising is prominently displayed on the store exterior or at checkout. Given that e-cigarette retail marketing receptivity is associated with underage purchase, policy and awareness initiatives should focus on mitigating the impact of advertisements, unlocked displays, product placement near food/candy, and free samples. These marketing strategies bring AYAs into close contact with e-cigarettes and create a retail environment that encourages purchase.