Understanding which advertising features systematically distort how young people perceive nicotine risk is now more urgent than ever, given the explosion of e-cigarette use among adolescents and young adults. Identifying the precise mechanics of misperception — rather than simply blaming marketing in general — offers regulators and public health advocates a more surgical target.
This preregistered two-wave survey enrolled 1,708 Americans aged 18–20 between 2022 and 2023. Participants viewed a randomized set drawn from 221 coded cigarette and e-cigarette advertisements, then rated each for perceived harm and addictiveness. Using mixed-effects logistic regression, researchers isolated which specific ad features — flavors, sweepstakes, social media engagement prompts, socialization themes, gift or price promotions, use cues, and pleasure claims — independently predicted inaccurate perceptions after adjusting for demographics, brand familiarity, and tobacco use history. For e-cigarettes, sweepstakes mechanics, social media engagement tactics, and socialization themes were each associated with elevated odds of inaccurately low harm and addiction perceptions. Paradoxically, ads featuring visible flavors or gift promotions were linked to more accurate harm appraisals, a counterintuitive pattern the authors attribute to possible salience effects.
This research fills an important gap: most prior tobacco marketing studies measured ad exposure volume rather than dissecting individual creative features. The mechanistic specificity here is genuinely useful. The sweepstakes and social-media-engagement findings are particularly noteworthy because these tactics are relatively recent digital adaptations that skirt traditional broadcast advertising regulations. The 18–20 age band is also strategically significant — this group sits just below the federal tobacco purchase age of 21 and represents a primary industry recruitment target. Key limitations include the cross-sectional, survey-based design, which measures associations rather than causal attitude change, and the reliance on self-reported perception ratings that may not translate to real-world purchasing behavior. Still, the granularity of ad feature coding elevates this above routine marketing surveillance, making it a credible evidence base for feature-specific regulatory action rather than blanket advertising restrictions.