The role of socioeconomic status in the association between advertising exposure and electronic cigarette use among young adults in China: A moderated mediation analysis

Introduction: Exposure to advertising is a determinant of electronic cigarette (e-cigarette) use among young adults. Few studies have explored the underlying mechanisms of advertising exposure on e-cigarette use among young Chinese adults.

Methods: An online survey was administered to a sample of 2956 young adults (aged 20–34 years) who were never smokers, from April to May 2022, in China. Mediation analyses were used to test the mediating effects of curiosity and harm perception, and moderated mediation models were conducted to examine whether the relationships in mediation modeling vary across different levels of socioeconomic status (household income, education level, and residence).

Results: Greater advertising exposure was associated with a higher likelihood of e-cigarette use (AOR=1.39; 95% CI: 1.26–1.54) and curiosity about e-cigarettes (AOR=1.33; 95% CI: 1.25–1.42), and the latter mediated the association between advertising exposure and e-cigarette use (proportion mediated=26.9%; 95% CI: 15.8%–40.7%) while harm perception did not. Additionally, the effect of advertising exposure on curiosity was moderated by household income (p=0.03) and residential area (p=0.001), and was stronger among participants with lower socioeconomic status.

Conclusions: E-cigarette advertising may promote young adults’ experimentation by increasing their curiosity towards the products. Socially disadvantaged groups may be more susceptible to e-cigarette advertising. The study suggests that the government should explore options for better regulation of e-cigarettes to prevent initiation by never smokers and protect vulnerable populations.