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Teens who owned promotional items for e-cigarettes and other alternative tobacco products are more likely to try these products, says a new study.The study, published in 'JAMA Network Open,' followed 757 California teens for a year before drawing the conclusion.At the beginning of the year, participants had never used alternative tobacco products, including e-cigarettes, chewing tobacco, cigars, cigarillos, pipes, and hookahs.But some participants owned marketing materials for these products, such as coupons, samples, and branded hats or T-shirts."We wanted to see how owning promotional materials would affect young people's use later on," said the study's lead author Hoda Magid.Among teens, cigarette smoking rates have dropped in recent decades, but their use of e-cigarettes and other tobacco products has risen sharply."The increase in the use of alternative tobacco products poses a threat to the decades of hard work that public health experts have done to reduce tobacco use," said Magid."We need to know trajectories of use of alternative tobacco products," said the study's senior author Bonnie Halpern-Felsher. "Understanding when and why youth start using such products is important for stemming the tide of addiction to them," she said.While marketing to minors and providing samples is illegal for all tobacco products, providing coupons and branded promotional items such as T-shirts and hats is not illegal for most alternative tobacco products, except smokeless tobacco. Enforcement of all policies is lacking, Halpern-Felsher said."The problem is that the FDA (Food and Drug Administration) has been very slow to enact new or enforce existing laws and regulations for e-cigarettes," Halpern-Felsher said."Right now, the FDA is not going after manufacturers who have not put in an application to market e-cigarettes."This means thousands of e-cigarettes and other alternative tobacco products are being marketed without any FDA review.When the study began, participants were 13 to 19 years old and attended California high schools. They completed questionnaires asking whether they had ever used traditional cigarettes or any alternative tobacco products and whether they or their friends owned promotional items such as coupons, free samples, T-shirts, posters and hats for any type of nicotine product.The researchers asked similar questions about the use of cigarettes and alternative tobacco products a year later and analysed changes in the teens' use of e-cigarettes and other tobacco products as a function of owning or receiving promotional materials.At the start of the study, 81 of the 757 participants owned items that promoted tobacco products including 52 who owned promotional items for e-cigarettes.Over the course of the study, 129 participants, or 17 per cent, began using alternative tobacco products but not traditional cigarettes.Twelve participants began using traditional cigarettes alone or in combination with alternative tobacco products. Before adjusting for confounding factors, teens who owned promotional items were found to be 2.23 times as likely to try alternative tobacco products as those who did not own such items.After adjusting for age, gender, race/ethnicity, maternal education level, and baseline alcohol and cigarette use, the teens who owned promotional materials were 2.13 times as likely as their peers to begin using alternative tobacco products.When teens who had tried both alternative tobacco products and cigarettes during the year were included in the analysis, the influence of owning promotional materials did not reach statistical significance.The findings provide evidence that ownership of marketing materials is strongly associated with more young people using e-cigarettes and other alternative tobacco products, the researchers said.The findings clearly show that no tobacco company, including any e-cigarette company, should be allowed to provide coupons, free samples or other marketing materials to teens, and suggest that the FDA should further restrict and enforce such marketing techniques, Halpern-Felsher said."Manufacturers say they're not marketing to teens, but teens are reporting owning these promotional items, and they are reporting the use of alternative tobacco products," Magid said.

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