Exposure to e-cigarette TV advertisements among U.S. youth and adults, 2013-2019.

INTRODUCTION: E-cigarette advertising has been shown to increase e-cigarette awareness and use. Although e-cigarette marketing in the early 2010s has been well-documented, little is known about how it has changed in recent years in response to the regulatory scrutiny from the FDA and the Congress to combat youth vaping epidemic. This study aims to examine the exposure to e-cigarette TV advertising among youth and adults in the U.S. from 2013 to 2019, overall and by media market and brand.
METHODS: Quarterly data on e-cigarette TV advertising exposure, measured by target rating points (TRPs), and expenditures from 2013 to 2019 were compiled from the StradegyTM of Kantar Media. Trends of quarterly e-cigarette advertising TRPs were reported by age group, market, and brand.
RESULTS: Over the study period, overall exposure to e-cigarette TV advertising was higher among adults than among youth. E-cigarette advertising TRPs and expenditures were relatively stable, despite intermittent fluctuations, between 2013 Q1 and 2017 Q1 except for a one-time dip in 2015 Q3, followed by a sharp decline in 2017 Q2 and stayed low till the end of 2018. A resurgence of e-cigarette advertising TRPs occurred in 2019 Q1, led by the advertising from JUUL, Blu, and Vuse, which peaked in the third quarter of 2019, with quarterly TRPs reaching 316.8 for youth and 1,701.9 for adults, and quarterly advertising expenditure totaling $31 million.
CONCLUSIONS: Significant variations, both over time and across media markets and brands, were observed for e-cigarette televised advertising between 2013 and 2019. Following a lull in TV advertising in 2017/18, major e-cigarette companies have substantially increased advertising of their products on American television since early 2019, resulting in a surge in exposure to e-cigarette advertising among both youth and adults. Our findings highlighted the importance of continued monitoring of e-cigarette advertising in the U.S.

Introduction

Awareness and use of e-cigarettes have grown substantially among U.S. youth and young adults since e-cigarettes entered the U.S. market around 2006/7 [1-3]. In 2020, 19.6% of high school students and 4.7% of middle school students reported using e-cigarettes in the past 30 days [4]. Studies indicated that increased use of e-cigarettes was, at least partially, attributed to increased e-cigarette awareness, which was influenced by e-cigarette marketing [5-9]. Unlike the advertising of combustible cigarettes, which had been banned on television and radio since 1971, e-cigarette advertising had been largely unregulated in the U.S. until very recently [1]. In 2016, approximately 80% of middle and high school students reported seeing e-cigarette advertising. The primary resources of exposure included retail stores, the Internet, television, and printed media [10].

The e-cigarette marketing strategies have evolved over time. Previous studies documented that total e-cigarette advertising expenditures on television, radio, print, Internet, and outdoors increased exponentially from 2011 to 2013/14 [11, 12], a period when this industry had consolidated into a few major brands either directly owned by the tobacco industry (e.g., Altria’s MarkTen) or acquired through mergers, acquisitions, partnerships, or other agreements with existing e-cigarette companies [1]. The early e-cigarette advertising occurred primarily on televisions and print media, using strategies borrowed from the marketing of conventional cigarette brands [13]. Starting in mid-2015, the emergence of JUUL e-cigarettes, a pod-based product resembling a USB flash drive, started a new transformation in the U.S. e-cigarette market [14]. JUUL’s success was at least partially attributable to its multiple successful social media marketing campaigns [15, 16].

JUUL’s early advertising was criticized for targeting youth by using content appealing to youth in their social media campaigns [16, 17]. In response to the youth vaping epidemic in the U.S., declared by the Surgeon General in 2018, several federal agencies have taken steps regulating and restricting e-cigarette marketing [18]. For example, beginning in April 2018, the U.S. Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) issued multiple warning letters to e-cigarette manufacturers, distributors, and retailers for promoting e-cigarette products in ways misleading to youth or selling e-cigarette products to youth illegally [19-21]. In September 2018, the FDA expanded its “The Real Cost” anti-tobacco campaign to target youth vaping and encouraged e-cigarette manufacturers to voluntarily take actions to prevent youth access to their products [22]. In November 2018, the FDA Commissioner Gottlieb proposed additional steps to prevent youth access to flavored tobacco products [23]. Pressed by investigations conducted by federal and state agencies, JUUL shut down its accounts on Facebook and Instagram, suspended most of its advertising activities, and withdrew flavored (except for menthol) JUULpods from the U.S. retail market in late 2018 and early 2019 [24, 25].

In part as a result of the FDA’s intense regulatory scrutiny, major e-cigarette companies altered their marketing strategy by reducing advertising on social media and increasing spending on TV advertising campaigns [24, 26–28]. In January 2019, JUUL launched its “Make the switch” marketing campaign, claiming to target adult cigarette smokers [28]. In their TV commercials, adult smokers shared various reasons why they switched to JUUL and their feelings after the switch [28]. Two competing brands, Blu and Vuse, followed the footsteps of JUUL and started advertising their own e-cigarette products on television. In March 2019, Reynolds launched a 30-second TV commercial, named “Innovation”, to promote Vuse Alto, which highlighted that it was time for innovation to change smoking and Vuse Alto provided these innovations smokers desired. In August, Vuse Alto was further promoted by featuring the “best price” in its TV commercial and each Vuse Alto device was sold only for 99 cents in participating retail stores [22, 27, 29]. From 2019 Q3, Blu e-cigarettes also launched its “Satisfaction” television ads to promote MyBlu device on TV featuring quality, simplicity, and real nicotine satisfaction [23].

Given the strength of the evidence on the relationship between e-cigarette advertising and use of this product, it is important to examine this strategic shift in e-cigarette marketing in the context of a rapidly changing regulatory environment and a rapidly changing media environment in the U.S. Unfortunately, existing studies of e-cigarette TV advertising have so far focused on the pre-2015 period, no studies have specifically examined televised e-cigarette advertising in the U.S. since 2015, a period when substantial changes occurred in the e-cigarette market, including the emergence of JUUL and other pod-based e-cigarettes. Duke et al. (2014) examined e-cigarette TV advertising exposure among youth and young adults in the U.S. from 2011 and 2013 using the Nielsen data [30]. They found that exposure to e-cigarette TV advertisements increased 256% among youth and 321% among young adults from 2011 to 2013 in the U.S. [30]. Tuchman (2019) examined the effect of e-cigarette TV advertising on the demand for combustible cigarettes using the Nielsen data from 2009 to 2015, but she did not report overall and market-level TV advertising exposure in her study [31]. In addition, previous studies either focused solely on e-cigarette TV ratings or on marketing expenditures, our study aims to present the data on both TV ratings and TV advertising expenditures. Furthermore, previous studies documented the aggregated e-cigarette TV advertising in the U.S. and did not examine the differences in e-cigarette advertising by media market/geolocation. This study filled these critical research gaps by systematically examining e-cigarette TV advertising exposure by age group, market, and product brand, from 2013 to 2019, which provided a more detailed and in-depth understanding of the televised e-cigarette advertising in the U.S.

Materials and methods

Data

The data on e-cigarette TV advertising and marketing expenditures were compiled from the StradegyTM of Kantar Media. Kantar Media is a data and consulting company that tracks advertising and marketing expenditures at product level for more than 3 million brands. Kantar Media tracks 20 media channels, including TV (network TV, spot TV, cable TV, etc.), print media, radio, online, mobile, video, etc. [32]. In this study, we analyzed e-cigarette-specific advertising data on all TV channels. E-cigarette TV advertising data were retrieved using a list of e-cigarette keywords, which was compiled from previous studies, and updated with additional keywords of new e-cigarette brands generated through Google searches, and searches on social media platforms such as Twitter, Instagram, YouTube, and Reddit [33, 34]. This list of e-cigarette keywords (see S2 Table), which included both generic terms for e-cigarettes (electronic cigarette, e-cig, ecig) and their components (e.g., cartridge, pod, e-juice), and slang terms (e.g., vape, vapor, vaping), was used to retrieve the e-cigarette TV advertising through Kantar Media’s search portal. Importantly, we also manually reviewed all products under Kantar product categories that we deemed likely to include e-cigarette products, such as “smoking materials and accessories” [34]. E-cigarette products identified from Kantar were carefully reviewed, and irrelevant products, such as “Nike Vapor”, were excluded from data analysis. Products under the same brand were grouped together (e.g., Vuse Alto, Vuse Ciro, Vuse Solo, and Vuse Vibe were all categorized under the Vuse brand). Our search of Kantar advertising data using this method yielded 31 unique e-cigarette brands and 259 vape shops. The TV advertising and expenditures data for these 31 brands and 259 vape shops for the period 2013 Q1 to 2019 Q4 were retrieved, compiled, and analyzed.

Measures

Quarterly target rating points (TRPs) were used to assess potential exposure to e-cigarette TV advertising among youth (aged 12–17) and adults (aged 18 years old). The TRPs were calculated as the multiplication of the percentage of people exposed to an advertisement and the average number of times this advertisement was seen by these viewers [35]. Take an advertisement with TRPs = 25 among youth in 2013 Q1 for an example, this ad was likely to have been viewed for an average of 5 times by 5% of youth, or an average of 1 time by 25% of youth in 2013 Q1. It should be noted that the TRPs is an aggregated measure of TV ratings in a media market, which may not represent the actual advertising exposure at the individual level.

Quarterly (from 2013 Q1 to 2019 Q4) televised advertising expenditure was defined as the estimated dollar amount spent by the e-cigarette companies to purchase advertising space on TV [32]. The quarterly e-cigarette TV advertising expenditure was summarized in the unit of $1,000 U.S. dollars without adjustment for inflation.

Analysis

Data management and analyses were conducted using Stata 15.0 (College Station, TX: StataCorp LLC.). We reported the quarterly TRPs of youth and adults, and the quarterly TV advertising expenditures. In addition, we identified the most advertised e-cigarette brands based on their total quarterly household gross rating points (GRPs, a measure of household TV ratings similar to TRPs without specific targeted population) from 2013 to 2019, and we calculated the market-level TRPs for youth and adults for all 210 media markets defined by Kantar Media. In this study, we reported the trends of quarterly TRPs by age for 10 media markets with the highest overall quarterly TRPs. Furthermore, we reported the trends of quarterly TRPs for seven most advertised e-cigarette brands by age over the study period.

Results

E-cigarette TV advertising TRPs and expenditures

Fig 1 displays the trends of quarterly e-cigarette TRPs among youth and adults and TV advertising expenditures (in $1,000) from 2013 Q1 to 2019 Q4. Over the study period, e-cigarette advertising TRPs for youth and adults were strongly correlated with the TV advertising expenditures (Pearson correlation = 0.60 for youth and = 0.94 for adults). The e-cigarette advertising TRPs among adults were consistently higher than those of youth. Despite intermittent fluctuations, e-cigarette advertising TRPs and expenditures were relatively stable between 2013 Q1 and 2017 Q1 except for a one-time dip in 2015 Q3. E-cigarette TV advertising were almost non-existent between 2017 Q2 and 2018 Q4, with only a few ads airing during the four quarters from 2017 Q2 to 2018 Q1. Both the youth and adult TRPs increased substantially in 2019 Q1 (from zero ratings to 100.8 among youth and to 528.1 among adults). E-cigarette marketing expenditure also reached to a new high of $12,120,900 in 2019 Q1. Adult TRPs peaked in 2019 Q3 (1,701.9), accompanied by the highest quarterly advertising expenditure ($31,287,100). In 2019 Q4, the expenditure dropped to $6,531,700, and TRPs also declined in both groups (64.9 for youth and 351.6 for adults). Detailed information was presented in S2 Table.

Fig 1

Quarterly e-cigarette TV advertising expenditures and TV target rating points (TRPs) among U.S. youth and adults, 2013–2019.

(A) February 24, 2018, FDA sent a letter to JUUL expressing concerns about the popularity of JUUL products among youth and requested documents regarding its marketing practices. (B) April 24, 2018, the FDA Commissioner announced new enforcement actions and a Youth Tobacco Prevention Plan to stop youth use of, and access to, JUUL and other e-cigarettes. (C) May 1, 2018, FDA and FTC took actions against companies misleading kids with e-liquids that resembled children’s juice boxes, candies and cookies. (D) June 2018, JUUL announced it would "no longer use models on social media platforms," instead focusing on testimonials from adult smokers who switched to JUUL. (E) September 12, 2018, FDA declared youth vaping as “an epidemic proportion” and put makers of the most popular e-cigarette devices on notice that they need to prove they can keep their devices away from minors. (F) September 18, 2018, FDA launched an anti-vaping media campaign. (G) November 15, 2018, the FDA Commissioner proposed a new plan to protect youth by preventing youth access to flavored tobacco products. (H) November 29, 2018, FDA warned companies for selling e-liquids that resemble kid-friendly foods as part of the agency’s ongoing Youth Tobacco Prevention Plan. (I) January 2019, JUUL launched its “Make the switch” marketing campaign. (J) March 2019, Reynolds launched a TV commercial, named “Innovation”, to promote Vuse Alto e-cigarettes. (K) August 2019, Blu launched its “Satisfaction” television ads to promote MyBlu e-cigarettes.

E-cigarette advertising TRPs in the top 10 media markets

We identified the top 10, out of 210, media markets with the highest cumulated TRPs from 2013 to 2019. Those top 10 media markets for youth, ranked from high to low, were: Oklahoma City (OK), Tulsa (OK), Pittsburgh (PA), Miami (FL), Buffalo (NY), Tri Cities (WA), Richmond (VA), Toledo (OH), Colorado Springs (CO), and Greenville (SC). The top 10 media markets for adults, ranked from high to low, were: Tulsa (OK), Oklahoma City (OK), Pittsburgh (PA), Colorado Springs (CO), Richmond (VA), Omaha (NE), Lexington (KY), Buffalo (NY), Miami (FL), and Sioux City (IA).

Figs 2 and 3 presented the trends of quarterly e-cigarette advertising TRPs in these 10 media markets, separately by youth and adults. For youth, Richmond was the media market with the highest TRPs (305.5) in 2013 Q1. Miami was the media market with highest TRPs in 2013 Q2 (600.1), Q3 (457.7) and 2014 Q1 (669.4). In 2013 Q4, Tulsa was the most advertised media market with TRPs of 869.5. Tulsa was also the market with the highest TRPs between 2014 Q2-2015 Q1. Oklahoma City had the highest TRPs between 2016 Q1 and 2017 Q4, during which the peak of youth TRPs occurred in 2017 Q1(767.4). Toledo had the highest TRPs in 2018 Q1 (341.6) and Q4 (80.8) and 2019 Q1 (310.0). Youth TRPs in these 10 markets did not differ substantially in the period of 2019 Q2-Q4. For adults, Richmond was the market with the highest TRPs in 2013 Q1(753.6) and Q2 (1,424.8). Miami was the market with the highest TRPs in 2013 Q3 (1,198.2). From 2013 Q4 to 2015 Q4, Tulsa was the market with the highest e-cigarette advertising TRPs, with the peak occurred in 2014 Q4 (2,890.4). Oklahoma City had the highest TRPs between 2016 Q1 to 2018 Q1, during which the highest TRPs occurred in 2017 Q1 (2,033.5). Omaha had the highest quarterly TRPs from 2018 Q2 to 2019 Q3, during which the maximum TRPs were observed in in 2019 Q3 (2,461.3).

Fig 2

Youth (age 12–17) quarterly e-cigarette TV target rating points (TRPs) by top 10 Nielsen retail market, 2013–2019.

Fig 3

Adult (age 18 and above) quarterly e-cigarette TV target rating points (TRPs) by top 10 Nielsen retail market, 2013–2019.

E-cigarette advertising TRPs for the top seven brands

Based on the household GRPs from 2013 Q1 to 2019 Q4, the top seven most advertised e-cigarette brands were: Blu (cumulative household GPRs = 7,037.6), Vuse (6,185.4), Logic (2,366.3), JUUL (2,270.0), Njoy (552.7), O2Pur (529.1), and Fin (225.5) (Table 1).

Table 1

TV ratings overall and by age groups and televised advertising expenditures of the top 20 advertised e-cigarette brands, 2013 to 2019.

Products	Youth (aged 12–17) TRPs	Adult (aged 18+) TRPs	Household GRPs	Expenditure (in 1,000 US dollar)
Blu	1,862.4	3,914.6	7,036.7	46,373.6
Vuse	1,172.3	3,484.0	6,185.4	43,384.4
Logic	340.1	1,335.8	2,366.3	10,679.0
JUUL	223.2	1,264.9	2,207.0	29,995.5
Njoy	154.6	321.3	552.7	6,308.5
O2Pur	105.1	294.0	529.1	9,951.6
Fin	43.8	126.0	225.5	1,339.5
21st Century Smoke	13.4	19.4	33.2	339.4
Starfire	4.6	8.0	15.0	776.3
Cue	3.0	7.1	13.0	216.2
Vchic	1.8	2.6	5.1	128.8
Square	1.2	2.4	4.4	32.3
VaporX	0.1	0.6	1.1	45.0
Vero	0.0	0.1	0.3	4.7
EsmokeUSA	0.2	0.1	0.3	8.1
Magic Mist	0.0	0.0	0.0	1.7
Grand Total	3,926.6	10,783.4	19,179.7	149,667.7

Figs 4 and 5 displayed the e-cigarette advertising youth and adult TRPs for the top 7 brands from 2013 Q1 to 2019 Q4. Over the study period, although adult e-cigarette advertising TRPs were consistently higher than those of youth, the time trends of TRPs for the two groups were similar. In 2013, Blu was the most advertised e-cigarette brand, measured by its quarterly TRPs, which reached the highest levels in 2013 Q2 (292.8 for youth and 572.6 for adults). Vuse overtook Blu in 2014 Q3, becoming the most advertised brand until 2015 Q4. The peak of Vuse TV advertising occurred in 2015 Q4 (233.0 for youth and 575.6 for adults). From 2016 Q3 to 2017 Q1, Logic’s ads were the most watched e-cigarette TV ads among U.S. youth and adults, with the highest TRPs occurring in 2017 Q1 (150.5 for youth and 619.9 for adults). Since 2019, the resurgence of e-cigarette ads on the U.S. television was driven entirely by the ads from Blu, JUUL, and Vuse. Both the youth and adult TRPs of these ads peaked in 2019 Q3 (youth: 111.0 for Blu, 100.4 for JUUL, and 104.9 for Vuse; adults: 512.9 for Blu, 546.8 for JUUL, and 640.8 for Vuse).

Fig 4

Youth (age 12–17) quarterly TV target rating points (TRPs) of the top 7 e-cigarette brands, 2013–2019.

Fig 5

Adult (aged 18 and above) quarterly TV target rating points (TRPs) of the top 7 e-cigarette brands, 2013–2019.

Discussion

Our paper provided important insights into the potential e-cigarette TV advertising exposures among American youth and adults since 2013, a period when significant changes, including the emergence of pod-based e-cigarettes such as JUUL, transformed the U.S. e-cigarette industry and marketplace. We found a resurgence in e-cigarette TV advertising since early 2019, after a lull in 2017/2018. Importantly, this resurgence was driven entirely by three major e-cigarette brands, Blu, JUUL, and Vuse. We also observed significant variations of e-cigarette TV advertising exposure across age groups, media markets, and brands.

When e-cigarette products first entered the U.S. market around 2007, they were sold primarily through online retailers with limited marketing [1]. Kornfield and colleagues (2015) did not find marketing expenditure tracked by Kantar Media until 2010 Q1 [34]. The marketing expenditures on e-cigarette TV advertising increased substantially in 2012 when big tobacco companies entered the e-cigarette market [1, 34]. Duke et al. (2014) calculated the quarterly TRPs from 2011 to 2013 using the Nielsen data. They found that quarterly youth TRPs increased from under 100 in the first half of 2012 to 347 in 2013 Q2, consistent with the 353 TRPs reported in our study [30].

Our study extended the previous research by examining the U.S. e-cigarette TV advertising exposure from 2013 through 2019. We found that the e-cigarette advertising TRPs in the U.S. were relatively stable, with intermittent fluctuations, from 2013 Q1 to 2017 Q1 (around 500 TRPs for adults and 200 TRPs for youth), except for a brief dip in 2015 Q3. In addition, our study showed that the average quarterly TV advertising expenditure was approximately $5.0 million from 2013 Q1 to 2017 Q1, consistent with the reports from several previous studies [12, 34]. The substantial marketing spending from 2013 to 2017 likely increased awareness of e-cigarettes and spurred large sales increases [36]. The e-cigarette TV advertising TRPs and expenditures remained low from 2017 Q2 to 2018 Q4, consistent with findings reported by Ali et al. (2020). The low level of e-cigarette TV ads during this period likely reflected a shift of e-cigarette companies’ marketing strategy from TV, print media and radio to less expensive online/internet advertising [12]. It may also reflect the strategic withdraw of e-cigarette advertising across media channels in response to the increased regulatory scrutiny from federal and state regulators.

After a lull in 2017/18, we found a resurgence in e-cigarette TV advertising in early 2019. Youth TRPs increased from 0.1 in 2018 Q4 to 101 in 2019 Q1, and adult TRPs skyrocketed from 0.3 in 2018 Q4 to 528 in 2019 Q1. E-cigarette advertising TRPs peaked in 2019 Q3 for adults, which reached 1,702. The TV advertising expenditures also reached the peak of more than $30 million in 2019 Q3. These are important findings not reported in previous studies, and represent one of the most important contributions of our study. Notably, the resurgence of e-cigarette TV advertising in 2019 were driven entirely by the ads from three major e-cigarette brands, Blu, JUUL, and Vuse. Previous studies showed the e-cigarette TV advertising expenditure in 2012 was mainly due to the spending of the Blu TV advertising campaigns on the national cable network [11]. Our results also suggested that e-cigarette TV advertising in the U.S. since 2013 was driven by a few major e-cigarette brands, including Vuse’s advertising campaign in 2015 and 2016, Logic’s advertising in 2017, and the TV advertising campaigns of JUUL, Vuse, and Blu in 2019.

The resurgence in e-cigarette TV advertising in 2019 likely reflected the industry’s response to the intense scrutiny from the investigations conducted by several federal agencies and states’ Attorney Generals’ offices on e-cigarette companies’ aggressive marketing on social media. According to a recent Nielsen report, as of 2019 Q2, the average amount of time American adults spent on internet and mobile apps (5:09 hours) has exceeded the average amount of time spent on TV (4:04 hours) per day [37]. Consequently, online advertising and advertising via search engines or mobile apps have become one of the most important ways to reach consumers. Absence of federal and state actions, e-cigarette companies were unlikely to significantly reduce their digital/social media marketing, given the current trend of media consumption.

The resurgence of e-cigarette TV advertising in 2019 may also reflect the industry’s strategic shift to focus on adult smokers, as all these three major TV advertising campaigns purportedly aiming at helping adult smokers switch to e-cigarettes. There were approximately 34.1 million adult smokers in the U.S. [38], only a small fraction (approximately 10%) of them were current e-cigarette users [39]. As such, adult smokers represent one of the most important potential markets for e-cigarette companies. For American adults, TV advertising remains one of the most important media channels today [37]. Consequently, the resurgence of e-cigarette TV advertising in 2019 likely reflected e-cigarette companies’ strategic decision to promote their products among targeted adult smokers.

In addition, we found that e-cigarette TV advertising TRPs for adults were consistently higher than those for youth during our study period, and the correlation between e-cigarette TV advertising expenditures and TRPs was stronger for adults than that for youth (Pearson’s correlation: 0.94 vs. 0.60). These results indicated the potential exposure of e-cigarette TV advertising was higher among adults than among youth during our study period, and there were potential spillover effects of e-cigarette TV advertising that were aimed at adults. For example, even though the three major e-cigarette TV advertising campaigns in 2019 were all purportedly targeted at adults, youth were exposed to these ads as well, which was evident by the significant increase in TRPs among youth in 2019. Given the evidence on the strong link between e-cigarette advertising exposure and e-cigarette use among youth [1, 9, 40], youth exposure of these TV ads in 2019 could translate into an increase in use of these products.

Our study also revealed significant variations of e-cigarette advertising exposure by media market/geolocations, representing another unique contribution of our study. For example, our results showed that the highest level of youth TV advertising TRPs occurred in the Miami media market in early 2013, followed by the Tulsa media market between late 2013 and early 2015, the Oklahoma City media market between 2016 and 2017, the Toledo media market in 2018, and the Pittsburg media market in 2019. This indicated that the likelihood of seeing an e-cigarette TV ad for youth differs by their location of residence, which could translate into difference in e-cigarette use behaviors.

The findings from our study have several important policy implications: first, the resurgence of televised e-cigarette advertising in 2019 suggests that a more comprehensive e-cigarette advertising regulatory framework may be warranted. Restrictions of youth-oriented e-cigarette advertising should be implemented across all media channels. If restrictions were placed only upon certain media channels, companies can continue promoting their products by shifting to unregulated media channels. Second, given the potential spillover effects of adult-oriented e-cigarette TV advertising, it is important to regulate the timing and location of these ads, and limit the media channels that air such ads. Third, anti-smoking and anti-vaping media campaigns, as well as other location-based tobacco control efforts, conducted by federal and state governments need to take into account the substantial variations in exposure to e-cigarette TV ads by media market/location. For example, in states/media markets where the exposure to e-cigarette TV ads was high, more frequent airing of anti-smoking and ani-vaping media campaigns may be needed. Finally, continued monitoring and surveillance of e-cigarette advertising is needed given the rapidly changing media landscape and the rapidly changing regulatory environment in the U.S.

This study is subject to several limitations. First, TRPs, the measure of potential exposure to e-cigarette TV advertisements, provide an estimate of ads exposure at an aggregated level, and may not represent actual individual level exposure. In addition, our study only reported TV advertising exposure and expenditures. E-cigarette advertising exposure through other channels, such as retail stores, print media, social media, sponsored events, and Internet promotions, were not examined in this study. Future studies can build on our current study to examine the e-cigarette advertising on these other channels.

Conclusions

Despite these limitations, this study provided important insights into the e-cigarette TV advertising exposures among American youth and adults in recent years, revealing a resurgence in e-cigarette TV advertising in 2019, driven entirely by three major e-cigarette brands. Despite FDA’s efforts to combat youth vaping started in 2018, e-cigarette television advertising TRPs and expenditures reached historical high levels in 2019, resulting in an increase in exposure to e-cigarette advertising among both American youth and adults. Given the rapid evolvement of the e-cigarette marketplace and the regulatory environment in the U.S., it is important to continue monitoring e-cigarettes’ advertising and promotional strategies through TV and other media channels, and use data to help guide e-cigarette regulations and policies at the national, state, and local levels.

List of keywords to retrieve e-cigarette TV advertising data from Kantar Media.

(DOCX)

Click here for additional data file.

Total quarterly e-cigarette TV advertising expenditure and quarterly e-cigarette TV ratings overall and by age groups, 2013 to 2019.

(DOCX)

Click here for additional data file.

13 Jan 2021

PONE-D-20-32877

Exposure to e-cigarette TV advertisements among U.S. youth and adults, 2013 – 2019

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Reviewer #1: Yes

Reviewer #2: Yes

**********

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Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: While I appreciate that the authors are reviewing a wide range of time covered by their data, the background section is very long and general. The manuscript would be stronger if the background section was more focused specifically on the issues directly addressed by the analysis.

The background also includes points that are not adequately connected to the paper’s central narrative. For example, it is unclear how the point summarized in the sentence on lines 87-89 demonstrates that federal agencies took a step to regulate e-cigarette marketing in an effort specifically “in response” to youth vaping as stated in the preceding sentence. Do the authors intend that the citation listed for this sentence demonstrates this by providing an example where FDA identified increasing youth vaping rates as motivation for the MRTP approval process and regulation of reduced harm claims? In cases such as this, I suggest the authors revise to make cited support for their argument more clear.

The authors assert on lines 100-101 that “TV remains the most commonly viewed media by youth and adults in the U.S.” with a citation from the Nielsen company dated Quarter 1 2012, almost 9 years ago. Given the rapidly changing media landscape, this assertion should have a more recent citation. This also not a trivial point given the trends that the authors review prior in the section about the increases e-cigarette company direct and indirect digital and social medial advertising driving youth e-cigarette rates. I suggest that the actions of e-cigarette company advertising being directed away from digital/social media back to TV should be contextualized with current information about TV viewership in light of media consumption trends and audience characteristics (with any attendant limitations noted).

Currently, the most directly relevant background information is given relatively short shrift in the paragraph on lines 100-113 (which is only 13 of the 71 lines of text in the section). I think space dedicated to this sort of directly relevant background needs to be better balanced with the disproportionately long preceding account of e-cigarette advertising history.

The sentence on lines 63-65 needs a citation.

Online 130 “Products belonged to the same brand were …” should be edited.

Overall, the approach, data, and methods are sound and consistent with prior studies using similar data that contextualize the results reported here.

In the Discussion section, the authors review the changes to e-cigarette company TV advertising in greater detail than in the background section. I think the paper would be stronger if the review and citations related to the various companys’ 2019 adult-focused ad campaigns was located in the background section to properly contextualize the results. For example, the dates of the various campaign launches across the quarters in 2019 correspond with increased TRPs displayed in the results. After informing the reader of these dates at the outset, the authors might consider adding indicator lines on the key quarters of campaign lunch displayed in figures to call readers’ attention to the corresponding results. Some of the less directly relevant literature reviewed in the background can be edited out to focus the section and accommodate the content.

The manuscript would also be stronger if the authors discussed potential implications of the trends they report beyond the recommendation for continued monitoring. Currently, the conclusions section is quite weak and lessens my enthusiasm for the manuscript. It is important to hear what authors think about their results framed as unintended consequences of FDA scrutiny that motivated changes in e-cigarette company advertising strategies and content. What might the authors expect to see (or not see) if there were continued monitoring? What consequences, for better or worse, do prior studies suggest we may expect from the trends reported here? Some of this is implied in the background and discussion, however the manuscript would be strengthened greatly by spending more space engaging directly in interpretation of results in the discussion section.

Reviewer #2: This study uses consumer media data to examine the exposure to e-cigarette TV advertising between 2013-2019, and more specifically how advertising has changes in response to tobacco regulation. The paper is well-written. The paper would benefit from a greater interpretation of how the findings may or may not relate to specific tobacco regulations enacted over the past 5 years. The Introduction would benefit from a more explicit description of how this study is unique from existing research. This study covers a longer period of observation than previous studies (2013-2019), however it seems other studies have evaluated advertising exposure by age group and evaluated sales by brand. Why is it necessary to measure marketing exposure when sales data are already available? Also, it would help to frame the reasons for studying differences in marketing exposure by market in the Introduction and interpret the results relevant to the market in the Discussion. As written, this analysis seems out of place. Alternatively, the authors might consider dropping the examination of TV advertising exposure by market from this paper.

Introduction

Line 45- update the high school and middle school e-cig prevalence data to reflect the 2020 estimates.

Lines 78-80- wording of sentence is awkward, consider revising. Is the sentence missing a word?

Methods

Line 120- The Kantar Media tracks TV ads across 20 types of media -- what is meant by 20 types of media? Is TV a type of media (as opposed to print/radio) or is this referring to something different? Please clarify.

Line 122- Consider adding the list of keywords as a supplementary files

Page 7 lines 129-130- Please provide more detail as to the process of "careful review" of e-cigarette products identified by Kantar.

Results

Consider condensing the description of Figure 1- focusing on the most salient points. The reader can refer to the figure for details.

The Introduction describes e-cigarette tobacco regulations related to marketing. The figures might benefit from an added overlay identifying when the regulations were enacted. This would allow the reader to easily interpret how regulations may or may not have affected marketing. Table 1 and Figure 1 are redundant-consider moving table 1 to supplementary materials.

Lines 203-207- The description of how the top brands were identified might be better placed in the Methods.

Discussion

The first paragraph of the discussion describes how the findings from this analysis are concordant with that previously reported in the literature- consider starting the paragraph with a concise summary of the unique findings from this paper- those perhaps that have not yet been reported in this paper. Also

Lines 231-238- The description of TV ad expenditure from 2010-2013 seems tangential to the Discussion- would focus more on the paper's findings rather than historical

Figure 1 shows TV ratings for youth and adults- Is this the TRP? Would use the term TRP throughout the Figures rather than rating if this is the case.

Figure 2&3are difficult to read due to many overlying lines- would consider dropping this analysis and Figure from the manuscript or changing the Figures presentation.

**********

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Reviewer #1: No

Reviewer #2: No

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3 Mar 2021

We have revised our manuscript according to the comments of editor and reviewers. Please see below for the point-to-point response to reviewers' comments.

Point-by-point responses to reviewers’ comments:

Reviewer #1:

Comment #1:

While I appreciate that the authors are reviewing a wide range of time covered by their data, the background section is very long and general. The manuscript would be stronger if the background section was more focused specifically on the issues directly addressed by the analysis.

Response to Comment #1: We appreciate this comment. Per this comment, we’ve shortened the background section, which now focused on articulating the rationale and motivation of our study, addressing issues directly relevant to our analysis. Our study was motivated by several critical gaps in the current literature: first, although previous studies have document televised e-cigarette advertising in the U.S. up to 2013, no studies have specifically examined televised e-cigarette advertising in the U.S. since 2014, a period when substantial changes occurred in the e-cigarette market, including the emergence of JUUL and other pod-based e-cigarettes, and more recent surge in e-cigarette TV advertising by three major brands since early 2019. Second, previous studies either focused solely on e-cigarette TV ratings or on marketing expenditures, our study presented the data on both TV ratings and TV advertising expenditures. Third, previous studies documented the aggregated e-cigarette TV advertising for the U.S. and did not examine the differences in e-cigarette advertising by media market/geolocation, our study filled these critical gaps. In addition, our study examined e-cigarette advertising by age group and by brand, providing a more rich and detailed understanding of the televised e-cigarette advertising in the U.S.

Comment #2:

The background also includes points that are not adequately connected to the paper’s central narrative. For example, it is unclear how the point summarized in the sentence on lines 87-89 demonstrates that federal agencies took a step to regulate e-cigarette marketing in an effort specifically “in response” to youth vaping as stated in the preceding sentence. Do the authors intend that the citation listed for this sentence demonstrates this by providing an example where FDA identified increasing youth vaping rates as motivation for the MRTP approval process and regulation of reduced harm claims? In cases such as this, I suggest the authors revise to make cited support for their argument more clear.

Response to Comment #2: We appreciate this comment. Although FDA’s MRTP approval process and regulation of reduced harm claims take into account the impact on youth population, they were not designed specifically to address the youth vaping epidemic. Per this comment, they’ve been deleted from lines 87-89 as examples of federal agencies’ response to youth vaping epidemic. The texts have now been revised to “In response to the youth vaping epidemic in the U.S., declared by the Surgeon General in 2018, several federal agencies have taken steps regulating and restricting e-cigarette marketing (1). For example, beginning in April 2018, the U.S. Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) issued multiple warning letters to e-cigarette manufacturers, distributors, and retailers for promoting e-cigarette products in ways misleading to youth or selling e-cigarette products to youth illegally (2-4). In September 2018, the FDA expanded its “The Real Cost” anti-tobacco campaign to target youth vaping and encouraged e-cigarette manufacturers to voluntarily take actions to prevent youth access to their products (5). In November 2018, the FDA Commissioner Gottlieb proposed additional steps to prevent youth access to flavored tobacco products (6).”

Comment #3:

The authors assert on lines 100-101 that “TV remains the most commonly viewed media by youth and adults in the U.S.” with a citation from the Nielsen company dated Quarter 1 2012, almost 9 years ago. Given the rapidly changing media landscape, this assertion should have a more recent citation. This also not a trivial point given the trends that the authors review prior in the section about the increases e-cigarette company direct and indirect digital and social medial advertising driving youth e-cigarette rates. I suggest that the actions of e-cigarette company advertising being directed away from digital/social media back to TV should be contextualized with current information about TV viewership in light of media consumption trends and audience characteristics (with any attendant limitations noted).

Response to Comment #3: This is a great suggestion. As this reviewer correctly pointed out, the media landscape in the U.S. has changed substantially since 2012, more recent data from the 2019 Nielsen reports indicated that in the past decade the amount of time Americans spent on watching TV has steadily declined, and at the same time, the amount of time spent on internet and mobile apps has increased significantly. As of 2019 Q2, the average amount of time Americans adults spent on internet and mobile apps (5:09 hours) has exceeded the average amount of time spent on TV (4:04 hours) per day. This provides important context for understanding e-cigarette company advertising strategies. Absence of federal actions, e-cigarette companies were unlikely to significantly reduce their digital/social media marketing, given the current trend of media consumption. The resurgence of e-cigarettes TV ads could therefore be better understood in the context of these important changes occurred in regulatory environment and media environment. However, TV remains an important media consumption channel for adults, a group purportedly targeted by e-cigarette companies in their 2019 TV ads, which claimed to help adult smokers to switch from combusted cigarettes. We explicitly discussed this in the revised manuscript.

Comment #4:

Currently, the most directly relevant background information is given relatively short shrift in the paragraph on lines 100-113 (which is only 13 of the 71 lines of text in the section). I think space dedicated to this sort of directly relevant background needs to be better balanced with the disproportionately long preceding account of e-cigarette advertising history.

Response to Comment #4: We appreciate this comment. Per this comment, we have shortened the first four paragraphs in the Introduction section and strengthened the most relevant background information.

Comment #5:

The sentence on lines 63-65 needs a citation.

Response to Comment #5: The citation has been added per this comment.

Comment #6:

On line 130 “Products belonged to the same brand were …” should be edited.

Response to Comment #6: Per this comment, this sentence has been revised as follows: “Products under the same brand were grouped together (e.g., Vuse Alto, Vuse Ciro, Vuse Solo, and Vuse Vibe were all categorized under the Vuse brand).”

Comment #7:

Overall, the approach, data, and methods are sound and consistent with prior studies using similar data that contextualize the results reported here.

Response to Comment #7: We appreciate the positive evaluation of our Materials and methods section by this reviewer. We added more details regarding the data collection process per Reviewer #2’s comments.

Comment #8:

In the Discussion section, the authors review the changes to e-cigarette company TV advertising in greater detail than in the background section. I think the paper would be stronger if the review and citations related to the various companies’ 2019 adult-focused ad campaigns was located in the background section to properly contextualize the results. For example, the dates of the various campaign launch across the quarters in 2019 correspond with increased TRPs displayed in the results. After informing the reader of these dates at the outset, the authors might consider adding indicator lines on the key quarters of campaign lunch displayed in figures to call readers’ attention to the corresponding results. Some of the less directly relevant literature reviewed in the background can be edited out to focus the section and accommodate the content.

Response to Comment #8: We appreciate this comment. Per this comment, we added the description on e-cigarette companies’ purportedly adult-focused TV ads in 2019 in the Introduction section. We also revised the figures adding indicator lines and texts highlighting the timing of various TV ad campaigns.

Comment #9:

The manuscript would also be stronger if the authors discussed potential implications of the trends they report beyond the recommendation for continued monitoring. Currently, the conclusions section is quite weak and lessens my enthusiasm for the manuscript. It is important to hear what authors think about their results framed as unintended consequences of FDA scrutiny that motivated changes in e-cigarette company advertising strategies and content. What might the authors expect to see (or not see) if there were continued monitoring? What consequences, for better or worse, do prior studies suggest we may expect from the trends reported here? Some of this is implied in the background and discussion, however the manuscript would be strengthened greatly by spending more space engaging directly in interpretation of results in the discussion section.

Response to Comment #9: We appreciate this comment. We agree with this reviewer that our conclusions section could be strengthened. In our revised manuscript, we addressed this comment by 1) adding more detailed discussion directly interpreting the results from our study, e.g. difference in ad exposure by age group, brand, and media market. 2) discussing the potential implications of the trends with/without additional federal actions restricting e-cigarette marketing. 3) discussing the potential unintended consequences of FDA actions and call for a comprehensive advertising regulatory framework that covers all media channels.

Reviewer #2:

Comment #1:

This study uses consumer media data to examine the exposure to e-cigarette TV advertising between 2013-2019, and more specifically how advertising has changes in response to tobacco regulation. The paper is well-written. The paper would benefit from a greater interpretation of how the findings may or may not relate to specific tobacco regulations enacted over the past 5 years. The Introduction would benefit from a more explicit description of how this study is unique from existing research. This study covers a longer period of observation than previous studies (2013-2019), however it seems other studies have evaluated advertising exposure by age group and evaluated sales by brand. Why is it necessary to measure marketing exposure when sales data are already available? Also, it would help to frame the reasons for studying differences in marketing exposure by market in the Introduction and interpret the results relevant to the market in the Discussion. As written, this analysis seems out of place. Alternatively, the authors might consider dropping the examination of TV advertising exposure by market from this paper.

Response to Comment #1: We appreciate this comment. Per the comment, we added a more explicit description of the rationale and motivation of our study and the unique contributions of our study in the Introduction section. Our study was motivated by several critical gaps in the current literature: first, although previous studies have document televised e-cigarette advertising in the U.S. up to 2013, no studies have specifically examined televised e-cigarette advertising in the U.S. since 2014, a period when substantial changes occurred in the e-cigarette market, including the emergence of JUUL and other pod-based e-cigarettes, and more recent surge in e-cigarette TV advertising by three major brands since early 2019. Second, previous studies either focused solely on e-cigarette TV ratings or on marketing expenditures, our study presented the data on both TV ratings and TV advertising expenditures. Third, previous studies documented the aggregated e-cigarette TV advertising for the U.S. and did not examine the differences in e-cigarette advertising by media market/geolocation, our study filled these critical gaps. In addition, our study examined e-cigarette advertising by age group and by brand, providing a more rich and detailed understanding of the televised e-cigarette advertising in the U.S.

Although previous studies have documented the sales of e-cigarettes in the U.S., these studies were based on Nielsen scanner data. These data captured sales of e-cigarette in Nielsen participating retail stores and did NOT capture a large portion (over 60%) of e-cigarette sales that occurred in non-participating retailers, online sales, and sales in vape shops and other tobacco specialty stores. In addition, sales data do not reveal marketing exposure among non-users. Consequently, sales should only be used as a supplement, not a substitute for adverting exposure data.

Per this comment, we added the texts describing the reasons for studying differences in marketing exposure by market in the Introduction. Interpretation of the results relevant to the market has now been added in the Discussion section. We also streamlined the analysis related to market difference.

Comment #2:

Introduction

Line 45- update the high school and middle school e-cig prevalence data to reflect the 2020 estimates.

Response to Comment #2: Per this comment, we updated the e-cigarette prevalence data among high school and middle school students to reflect the 2020 estimates.

Comment #3:

Lines 78-80- wording of sentence is awkward, consider revising. Is the sentence missing a word?

Response to Comment #3: We appreciate this comment. Per comment #1 and the comment from the other reviewer, this sentence has been removed in the revised manuscript.

Comment #4:

Methods

Line 120- The Kantar Media tracks TV ads across 20 types of media -- what is meant by 20 types of media? Is TV a type of media (as opposed to print/radio) or is this referring to something different? Please clarify.

Response to Comment #4: The Kantar Media covered a variety of media types, including TV channels (Network TV, Spot TV, Spanish Language Network TV, Cable TV, Syndication, local TV) and Non-TV media platforms (Magazines, Sunday Magazines, Local Magazines, Hispanic Magazines, B-to-B Magazines, National Newspapers, Newspapers, Hispanic Newspapers, Network Radio, National Spot Radio, Local Radio, Local Radio Historical, Internet Display, Mobile Web, Mobile App, Online Video, Mobile Web Video, Internet Search, Outdoor). In this study, we combined the ratings of all TV channels. We clarified this in our revised manuscript.

Comment #5:

Line 122- Consider adding the list of keywords as a supplementary file.

Response to Comment #5: Per this comment, the list of keywords has been added in S1 Table.

Comment #6:

Page 7 lines 129-130- Please provide more detail as to the process of "careful review" of e-cigarette products identified by Kantar.

Response to Comment #5: We clarified this “review” process in the revised manuscript. The primary purpose of this review was to identify “false positives,” i.e. product names that contain the prespecified keywords but are not e-cigarette products. For example, “Nike Vapor” contains a keyword “vapor,” but is not an e-cigarette product. As such, advertising data associated with “Nike Vapor” were removed from the search results. Per this comment, this sentence was revised as follows: “E-cigarette products identified from Kantar were carefully reviewed, and irrelevant products, such as “Nike Vapor”, were excluded from data analysis.”.

Comment #7:

Results

Consider condensing the description of Figure 1- focusing on the most salient points. The reader can refer to the figure for details.

Response to Comment #6: Per this comment, we shortened the description of Figure 1 to focus on the most important results, as well as presenting the data that were not explicitly depicted by Figure 1. This paragraph has been revised as follows:

“Fig 1 displays the trends of quarterly e-cigarette TRPs among youth and adults and TV advertising expenditures (in $1,000) from 2013 Q1 to 2019 Q4. Over the study period, e-cigarette advertising TRPs for youth and adults were strongly correlated with the TV advertising expenditures (Pearson correlation = 0.60 for youth and = 0.94 for adults). The e-cigarette advertising TRPs among adults were consistently higher than those of youth. Despite intermittent fluctuations, e-cigarette advertising TRPs and expenditures were relatively stable between 2013 Q1 and 2017 Q1 except for a one-time dip in 2015 Q3. E-cigarette TV advertising were almost non-existent between 2017 Q2 and 2018 Q4, with only a few ads airing during the four quarters from 2017 Q2 to 2018 Q1. Both the youth and adult TRPs increased substantially in 2019 Q1 (from zero ratings to 100.8 among youth and to 528.1 among adults). E-cigarette marketing expenditure also reached to a new high of $12,120,900 in 2019 Q1. Adult TRPs peaked in 2019 Q3 (1,701.9), accompanied by the highest quarterly advertising expenditure ($31,287,100). In 2019 Q4, the expenditure dropped to $6,531,700, and TRPs also declined in both groups (64.9 for youth and 351.6 for adults).”

Comment #8:

The Introduction describes e-cigarette tobacco regulations related to marketing. The figures might benefit from an added overlay identifying when the regulations were enacted. This would allow the reader to easily interpret how regulations may or may not have affected marketing. Table 1 and Figure 1 are redundant-consider moving table 1 to supplementary materials.

Response to Comment #7: This is a great suggestion. Per this comment, we have added an overlay identifying when the regulations were enacted and the timing of key e-cigarette TV ads in Figure 1 and moved Table 1 to the supplementary materials.

Comment #9:

Lines 203-207- The description of how the top brands were identified might be better placed in the Methods.

Response to Comment #8: Per this comment, we have moved the description of how the top brands were identified to the Methods section.

Comment #10:

Discussion

The first paragraph of the discussion describes how the findings from this analysis are concordant with that previously reported in the literature- consider starting the paragraph with a concise summary of the unique findings from this paper- those perhaps that have not yet been reported in this paper.

Response to Comment #9: Per this comment, we started the first paragraph of the discussion section with a concise summary of the unique findings from our study. It now starts as follows: “Our paper provided important insights into the potential e-cigarette TV advertising exposures among American youth and adults since 2013, a period when significant changes, including the emergence of pod-based e-cigarettes such as JUUL, transformed the U.S. e-cigarette industry and marketplace. We found a resurgence in e-cigarette TV advertising since early 2019, after a lull in 2017/2018. Importantly, this resurgence was driven entirely by three major e-cigarette brands, Blu, JUUL, and Vuse. We also observed significant variations of e-cigarette TV advertising exposure across age groups, media markets, and brands.”

Comment #11:

Lines 231-238- The description of TV ad expenditure from 2010-2013 seems tangential to the Discussion- would focus more on the paper's findings rather than historical

Response to Comment #10: Per this comment, we shortened the discussion on the historical findings and focused on the study period from 2013 to 2019.

Comment #12:

Figure 1 shows TV ratings for youth and adults- Is this the TRP? Would use the term TRP throughout the Figures rather than rating if this is the case.

Response to Comment #11: Yes, the ratings were TRPs. We have changed the term to “TV targeted rating points (TRPs)” throughout the Figures in the revised manuscript.

Comment #13:

Figure 2&3are difficult to read due to many overlying lines- would consider dropping this analysis and Figure from the manuscript or changing the Figures presentation.

Response to Comment #12: Figures 2 & 3 presented important results by media market. We believe it is important to include these figures in the manuscript. Per this comment, we changed the presentation of these Figures to make it easier for readers to identify media market.

Reference

1. Links C. Surgeon General’s Advisory on E-Cigarette Use among Youth. Arizona Free Press: Rockville, MD, USA; 2018.

2. Truth Initiative. E-cigarettes: Facts, stats and regulations 2019 [Available from: https://truthinitiative.org/research-resources/emerging-tobacco-products/e-cigarettes-facts-stats-and-regulations.

3. U.S. Food and Drug Administration. FDA, FTC take action against companies misleading kids with e-liquids that resemble children’s juice boxes, candies and cookies 2018 [Available from: https://www.fda.gov/news-events/press-announcements/fda-ftc-take-action-against-companies-misleading-kids-e-liquids-resemble-childrens-juice-boxes.

4. U.S. Food and Drug Administration. Warning Letters and Civil Money Penalties Issued to Retailers for Selling JUUL and Other E-Cigarettes to Minors 2018 [Available from: https://www.fda.gov/tobacco-products/ctp-newsroom/warning-letters-and-civil-money-penalties-issued-retailers-selling-juul-and-other-e-cigarettes.

5. Rogers K. The FDA Is Launching An Anti-Juul Campaign That’s Like D.A.R.E. for Vaping 2018 [Available from: https://www.vice.com/en_us/article/zm5nw4/the-fda-is-launching-an-anti-juul-campaign-thats-like-dare-for-vaping.

6. U.S. Food and Drug Administration. Statement from FDA Commissioner Scott Gottlieb, M.D., on proposed new steps to protect youth by preventing access to flavored tobacco products and banning menthol in cigarettes 2018 [Available from: https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-proposed-new-steps-protect-youth-preventing-access.

Submitted filename: Response to Reviewers.docx

Click here for additional data file.

22 Apr 2021

Exposure to e-cigarette TV advertisements among U.S. youth and adults, 2013 – 2019

PONE-D-20-32877R1

Dear Dr. Huang,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Comments to the Author

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Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

**********

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The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

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Reviewer #1: Yes

Reviewer #2: Yes

**********

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Reviewer #1: Yes

Reviewer #2: Yes

**********

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PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: I appreciate the authors' thoughtful responses to my various comments. Given the various revisions, I believe the manuscript is stronger and there is now enhanced clarity of the value posed by the results.

Reviewer #2: (No Response)

**********

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Reviewer #1: No

Reviewer #2: No

29 Apr 2021

PONE-D-20-32877R1

Exposure to e-cigarette TV advertisements among U.S. youth and adults, 2013 – 2019

Dear Dr. Huang:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

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