Kool Aid and Gummi Bear e-Cigarettes: Is the Target Population Changing?

A new study conducted by the Behaviour and Health Research Unit at the University of Cambridge, England, has confirmed the reason for increased e-cigarette use by children. Published in BMJ Tobacco Control, the study found that advertisements that promote e-cigarettes with flavors such as chocolate and bubble gum are more likely to attract school children to buy and try e-cigarettes than those featuring non-flavored e-cigarettes.

For their study, the authors sorted nearly 600 school children (11 to 16 years) children into 3 groups, each treated to one of the following conditions:

· Advertisements for flavored e-cigarettes

· Advertisements for non-flavored e-cigarettes

· No exposure to advertisements

The primary outcome evaluated was appeal of tobacco smoking, and secondary outcomes of the trial included appeal of using e-cigarettes, susceptibility to tobacco smoking, perceived harm of tobacco, appeal of e-cigarette advertisements, and interest in buying and trying e-cigarettes. After excluding existing smokers and e-cigarette users from the cohort, the analyses found that exposure to the ads did not increase the appeal of tobacco smoking, the appeal of using e-cigarettes, or susceptibility to tobacco smoking. However, advertisements for flavored e-cigarettes did garner the children’s interest in trying the products.

“Our results point to a need for further examination of the rules surrounding e-cigarette advertising especially in light of the growing popularity of e-cigarettes among children,” the authors write.

According to lead author Milica Vasiljevic, PhD, “We’re cautiously optimistic from our results that e-cigarette ads don't make tobacco smoking more attractive, but we’re concerned that ads for e-cigarettes with flavors that might appeal to school children could encourage them to try the products.”

This is definitely a concern in the United States as well, where results from the 2014 National Youth Tobacco Survey found a tripling of e-cigarette use in just a year between 2013 and 2014 among middle and high school students. The study found that 13.4% of high schoolers used an e-cigarette at least once every 30 days in 2014 (up from 4.5% in 2013), and 3.9% of middle schoolers did so in 2014 (up from just over 1% in 2013).

“We know that flavors appeal to kids, and that is what the e-cigarette industry is banking on,” Erika Sward, assistant vice president of national advocacy for the American Lung Association, said in an interview with CBS News. “Kids like sweet flavors. That is why there are sugar-sweetened cereals. These flavors have always appealed to a kid’s palate.”

“It doesn't get much more blatant. It's quite clearly targeted at kids,” Cliff Douglas, director of the American Cancer Society Tobacco Control Center, said in his interview with the news channel, as he discussed e-cigarette flavors such as sweet tarts, Hawaiian punch, Kool-Aid, gummi bears, and froot loops.

Leading oncology societies have raised their concerns with this growing trend of e-cigarette use by young children whose brains are still undergoing developmental changes. In a joint statement, the American Society of Clinical Oncology and the American Association of Cancer Research expressed concern that e-cigarettes may promote nicotine consumption by non-smokers, especially children, who could develop nicotine addiction. They also suggested FDA regulation of these products.