AJPH RESEARCH

Leading-Brand Advertisement of Quitting

Smoking Benefits for E-Cigarettes
Divya Ramamurthi, MA, Phillip A. Gall, BS, Noel Ayoub, BS, and Robert K. Jackler, MD

Objectives. To provide regulators and the US Food and Drug Administration with Administration (FDA) has deemed
a description of cessation-themed advertising among electronic cigarette (e-cigarette) e-cigarettes to be tobacco products and
brands. therefore under its regulatory authority.9
Methods. We performed a content analysis of 6 months (January through June 2015) An initial set of regulations included pro-
hibitions on underage sales and distribution
of advertising by e-cigarette brands on their company-sponsored social media channels
of free samples as well as inclusion of warning
and blogs as well as user-generated content (testimonials) appearing within brand-
labels concerning the addictiveness of nico-
sponsored Web sites. An explicit claim of cessation efficacy unambiguously states that
tine. Many youth-targeted e-cigarette mar-
e-cigarettes help in quitting smoking, and implicit claims use euphemisms such as “It keting practices have yet to be addressed.
works.” We selected a cohort of 23 leading e-cigarette brands, either by their rank in Examples of existing regulations that apply
advertising spending or their prevalence in Internet searches. to traditional combustible cigarettes, but
Results. Among leading e-cigarette brands, 22 of 23 used cessation-themed adver- not yet to e-cigarettes, include bans on
tisements. Overall, 23% of the advertisements contained cessation claims, of which 18% youth-oriented flavors, television and radio
were explicit and 82% were implicit. advertising, sponsorships (such as sporting
Conclusions. Among leading e-cigarette advertisers, cessation themes are prevalent events, concerts), and celebrity endorsements.
with implicit messaging predominating over explicit quit claims. Most relevant to this study, these FDA
Policy implications. These results can help the Food and Drug Administration clarify deeming regulations do not address adver-
tising claims.
whether tobacco products should be regulated as drugs with therapeutic purpose or as
Unconstrained by regulation, advertising
recreational products. (Am J Public Health. 2016;106:2057–2063. doi:10.2105/AJPH.
of e-cigarettes recapitulates now-banned
2016.303437)
methods of combustible tobacco advertis-
ing such as television commercials,
celebrity endorsements, assertions of

U se of electronic cigarette (e-cigarette)

products has increased many-fold in
recent years among both youths and adults.
In 2014, about 2.4 million youths were
current users of e-cigarettes, three times as
many as those who used the products in
2013. More youths now use e-cigarettes
than use conventional cigarettes.1 Of con-
cern, these nicotine-containing products
have addictive potential.2 Ever use among
adults was 12.6% in 2014, with current
smokers and former smokers who quit
within the past year more likely to use
the product.2 Among current cigarette
smokers who had tried to quit smoking
in the past year, 55.4% had ever tried
an e-cigarette and 20.3% were current
e-cigarette users.3
Promotional spending for e-cigarette
products increased almost 18-fold between
2011 and 2014, from $6.4 to $115 million,
and spending is expected to further increase
in 2016.4 Although e-cigarette products are
advertised across traditional media
channels (e.g., broadcast, print, and retail
stores), they are predominantly marketed
healthfulness, therapeutic claims, and even
images of doctors.10–13 One genre of ad-
vertising that we have not encountered in
online through brand-sponsored Web sites, the Stanford Research Into the Impact
social media, and e-mail.5 In 2014, an es- of Advertising (SRITA) collection of
timated 69% of middle- and high-school more than 25 000 combustible cigarette
students (18 million) were exposed to advertisements is an assertion of tobacco
e-cigarette advertisements, 10 million of cessation efficacy—this form is unique to
whom viewed the advertisements online.4 e-cigarettes.
Studies have found that exposure to In September 2015, the FDA proposed
e-cigarette advertising is associated with rules intended to clarify when tobacco
greater curiosity to use the product and products, including e-cigarettes, should be
misperceptions about the safety of the regulated as drugs, which will include
product.6–8 addressing advertising claims.14 The FDA is
Proposed in April 2014 and finalized concerned that advertising of products
in May 2016, the US Food and Drug intended for recreational use as smoking
ABOUT THE AUTHORS
All of the authors are with Stanford Research Into the Impact of Tobacco Advertising, Stanford University School of Medicine,
Stanford, CA.
Correspondence should be sent to Robert K. Jackler, MD, Stanford University, School of Medicine, Stanford, CA 94305 (e-mail:
jackler@stanford.edu). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.
This article was accepted August 10, 2016.
doi: 10.2105/AJPH.2016.303437

November 2016, Vol 106, No. 11 AJPH Jackler et al. Peer Reviewed Research 2057
AJPH RESEARCH

cessation devices may confuse consumers. In Google Search

Kantar Media
their proposed rules, the FDA specifically Ad Spending Advanced Personal Vaporizers
invited comment on cessation claims in
e-cigarette advertising. The goal of this
study is to provide regulators with a detailed
description of the slogans and imagery
50 Remaining 29 APV Brands
used by brands to advertise cessation efficacy. 55 Top Ad Spending
Top Ad Spending
We achieved this by quantifying and cate- 8 already included
gorizing claims of cessation efficacy, both via Kantar method

explicit and implicit, made by e-cigarette Random

Vuse and 21 APV Brands
brands. In our preliminary study of more Mark Tena Selection

than 12 000 e-cigarette advertisements in Search

Frequency
our online collection, we recognized that
commercially generated cessation claims 10 Most Prominent
3 Top Ad Spending 10 Randomly Selected
were especially prevalent in brand- Cigalike Brands APV Brands
Cigalike Brands
sponsored social media outlets and blog
postings as well as in user-generated a
Vuse and Mark Ten brands excluded because of lack of social media use.
content (testimonials) contained within
brand Web sites.15 FIGURE 1—Brand Selection Methodology for Content Analysis of Advertising by e-Cigarette
Brands Online From January Through June 2015

METHODS
We used 2 complementary methods to
identify 25 highly promoted e-cigarette
brands (Figure 1). Kantar Media (http://
www.kantarmedia.com) tracks advertise-
ments for more than 90 000 brands in
more than 400 consumer magazines, 4500
Web sites, 200 newspapers, 87 cable TV
networks, and 4000 radio stations in the
United States.16 A Kantar Media search of
e-cigarette brands advertising in both tradi-
tional and online channels, between January
2013 and January 2015, generated a list of
55 e-cigarette brands. We selected the top-5
e-cigarette brands with the overall highest
advertising spending. We used a randomizer
to select the remaining 10 brands from the
Kantar Media list.
Because Kantar Media did not track ad-
vertising spending of advanced personal va-
porizer (APV) brands, we conducted iterative
Internet searches to select 10 prominent
brands in this category. In July 2015, we
conducted comprehensive searches of
e-cigarette brands by using the US-based
versions of 3 search engines (Google, Yahoo,
and Bing) pairing the terms “vaporizer” or
“vape” with “advanced personal,” “advanced
vaporizer,” “modifier vaporizer,” “MOD,”
and “tank.” In addition, we searched the term
“tank” with multiple variations of the term
“e-cigarette.” Before each search, we deleted
the browser history and cache to prevent
tailoring of search results on the basis of
previous use. We recorded the first 5 pages
of each search to capture e-cigarette brands
selling APVs. This yielded a diverse set of
1465 Web sites, which yielded 29 APV
brands. Eight of these brands had already
been selected for inclusion to the study
through the first search methodology.
Of the remaining 21 brands, we selected
the top-10 brands with the highest
frequency of search results for inclusion in
the sample.
Inclusion Criteria for Advertising
Material
We focused upon commercially generated
content in e-cigarette brand–sponsored social
media outlets and Web site blogs. We also
included user-generated content in the form
of testimonials on brand Web sites. We ex-
cluded online sites not clearly attributable to
the brand, such as third-party retailer Web
sites and social media outlets. Of the 25 brands
identified as described (15 from Kantar Media
and 10 from Internet search prevalence), only
Mark Ten and Vuse limited their online
advertising to branded Web sites and did not
maintain any social media presence during
the study period. We therefore excluded
those 2 brands. The resulting study sample
consisted of 23 e-cigarette brands that mar-
keted either cigalikes (i.e., e-cigarettes that
looked like cigarettes) (6), APVs (5), or both
cigalike and APV products (12).
Among the 23 brands we studied, each
hosted a branded Web site, a Facebook page,
and a Twitter account. In addition, linked to
their Web site, 20 brands maintained blogs
and 12 had testimonial features. Because
blogs and testimonials frequently lacked
dates, we included all blog entries and tes-
timonials available on the brand Web site in
the study population. We included Face-
book posts and tweets made over a 6-month
period between January 2015 and June
2015 for study. During the period of analysis,
the brands generated a total of 3786 blog
posts, 699 testimonials, 3527 Facebook
posts, and 4508 tweets. Because the effort
required to code this large volume of data
would have been prohibitive, we randomly
sampled 10% of the generated posts. The
selected sample consisted of 1427 adver-
tisements including 408 Facebook, Twitter,
and blog posts, respectively, and 203
testimonials.
We used R version 3.2.3 (Free Software
Foundation, Boston, MA) to select a strati-
fied random sampling scheme stratified
by product category (i.e., cigalikes, APVs,
and both) and to channel coding units in
a manner that guaranteed that posts from
each stratum would be represented. Be-
tween the sample selection and content
coding, the brands had pulled down a subset

2058 Research Peer Reviewed Jackler et al. AJPH November 2016, Vol 106, No. 11

of 24 tweets and 78 blog posts and, thus, they
were not available for analysis. After this
adjustment, the study sample comprised 330
blog posts, 203 testimonials, 408 Facebook
posts, and 384 tweets.
Content Analysis Code Book
Development
In preparation for this study, we reviewed
thousands of e-cigarette advertisements
from the SRITA database and used this
familiarity with the industry’s advertising
practices to draft a coding instrument.
We then tested the resultant guide for in-
terobserver congruency and then we refined,
retested, and finalized it. The coding in-
strument captured basic Web site or social
media origination and cessation-specific
information.
The first set of coding variables was pri-
marily related to capturing basic information
about the testimonial, blog, or social media
post including date of publication and Web
site URL. If the advertisement contained
hyperlinks to external Web sites, we captured
the hyperlink and analyzed its contents for
a cessation claim. We tracked the presence
or absence of a cessation claim on a hyper-
linked text or video separately from cessation
claims made by the brands in the advertising
text or image. We considered cessation
claims made only through hyperlinks sepa-
rately and did not include these in our
data tables.
The second set of coding variables ex-
amined the advertisements for the presence or
absence of either an explicit or implicit ces-
sation claim, or both. An explicit claim of
cessation efficacy unambiguously stated that
e-cigarettes help in quitting smoking. An
implicit claim of cessation efficacy used eu-
phemisms but not an overt claim of “quit”
or “stop.” The presence of an implicit claim
or explicit claim was not mutually exclusive as
brands sometimes made an implicit claim
of cessation efficacy in their Facebook post
or tweet but made an explicit claim of ces-
sation efficacy in text or video that was
hyperlinked to the social media post.
When an advertisement was coded for
cessation efficacy, we characterized supple-
mentary messages. Such messages included
less harmful to health, short-term health
benefits (e.g., breathe better, no smoker’s
November 2016, Vol 106, No. 11 AJPH
AJPH RESEARCH
cough), long-term health benefits (e.g., no
cancer), alleviation of a specific medical
condition (e.g., Alzheimer’s disease), re-
duction or withdrawal of symptoms, lack of
weight gain, cleaner than combustible ciga-
rettes, better monetary value than combus-
tible cigarettes, better than other e-cigarette
brands, similar routine as cigarettes, reduction
of social pressure, freedom to use anywhere,
environmentally friendly, and increased
control over the experience.
Before coding the study sample, we
established intercoder reliability by using
a purposive sample of advertisements. Two
of the authors coded a pilot sample of 57 FIGURE 2—Explicit Smoking-Cessation
advertisements. To assess intercoder re- Claim in an NJOY e-Cigarette (Soterra Inc)
liability, we used Krippendorf ’s a, which Facebook Advertisement
measures disagreement between the coders
and corrects for chance agreement.17 To
cessation-related testimonials on the brand’s
be fairly certain that the data under consid-
Web page along with a disclaimer. For in-
eration are at least similarly interpretable by
stance, a consumer testimonial posted on
researchers, it is customary to require an a
the Veppo brand Web site said, “I smoke
greater than or equal to 0.800. In the pilot
around 2 pks as well, and have been wanting
study, the a value for explicit claims was
to quit, or at least cut down for a long time.
0.901 and for implicit claims was 0.954. For
Now, I finally think it is going to work!”
the other variables under study, a values
Alongside this testimonial was an editorial
ranged from 0.849 to 1.0.
note: “We do not endorse the e-cigarette as
a quit smoking device.”
RESULTS Frequency of Cessation Claims
An explicit claim of cessation efficacy Cessation-themed advertising was used by
contained a slogan or image conveying an 22 of 23 brands in the study. Among the 1323
unambiguous message that e-cigarettes help advertisements evaluated, 304 (23.0%) con-
in quitting smoking (Figure 2; Figures A–D, tained cessation claims (Table 2). Of these,
available as supplements to the online version 55 (18.0%) were explicit and 249 (81.9%)
of this article at http://www.ajph.org). were implicit in their messaging.
Such advertisements contained slogans When we considered hyperlinks listed
with key words such as “quit,” “stop,” in online advertisements, an additional 1.8%
“never,” and “smoke-free” (Table 1). of the sample contained cessation messages,
Some explicit cessation advertisements raising the total to 24.8%. Of the 66 adver-
conveyed their message with imagery such tisements with hyperlinks, 27 (41.0%) linked
as a broken cigarette, a snuffed-out butt, or to content created by the brand; 25 (37.9%)
a trail of ashes. linked to media articles; 11 (16.6%) linked to
An implicit claim of cessation efficacy third-party reviews, blogs, and Pinterest
contained a slogan with a euphemistic, but pages; and 3 (4.5%) linked to either a scientific
nevertheless clear, message to use the product study (n = 2) or an advocacy site (n = 1).
to quit smoking (Figure 3; Figures E–I,
available as supplements to the online ver-
sion of this article at http://www.ajph.org). Cigalike vs Advanced Personal
The most common key words within implicit Vaporizers
slogans were “switch” and “alternative” Among the 550 cigalike advertisements,
(Table 1). 130 (23.6%) contained cessation messages:
Some of the brands also provided 17 (13.1%) of these were explicit and
contradictory information by posting 113 (86.9%) implicit. Among 237 APV
Jackler et al. Peer Reviewed Research 2059
AJPH RESEARCH

TABLE 1—Representative Sample of Cessation Slogans for Electronic Cigarette Brands

a health perspective, it would be desirable
for addicted cigarette smokers to halt com-
Product Slogan bustible products and satisfy their nicotine
addiction by other means. Regarding
Explicit
e-cigarette cessation efficacy, one recent
Krave When did you quit smoking and start vaping?
meta-analysis suggested at most a minor
Nuvo An excellent way to slowly wean off from traditional cigarette dependency.
and non–statistically significant benefit when
NJOY Let’s obsolete cigarettes.
compared with established methods (patches
Veppo I am never smoking again.
Vaping has helped thousands quit smoking.
and gums) with success rates below 10%
These babies kept me smoke free for 19 mo now. among smokers seeking to quit.18 Another
Quit smoking today! You can do it. meta-analysis concluded that e-cigarette use
EverSmoke e-cigarettes are more than an ultimate cessation device. actually encouraged continued combustible
Don’t quit cold turkey. cigarette use.19 Given the lack of scientific
Provape 95% of vapers plan never to go back to Analogs again. evidence regarding cessation efficacy, there
How long were you a smoker before you started to vape? is no rational basis for e-cigarette brands to
V2 Quit smoking now! assert cessation efficacy when advertising their
It’s never too late to quit.
products.
Innokin The most successful smoking cessation product anyone has as yet invented.
The 2016 FDA deeming regulations do not
South Beach Smoke Cigarettes to help stop smoking.
address advertising claims.9 In September 2015,
Implicit the FDA drafted guidelines for public comment
Blu Why quit? Switch to Blu. to define which nicotine containing products
Blu is the smart choice for smokers wanting a change. should be regulated as drug delivery systems
Blu Plus works for me.
Rise from the ashes.
and which fall under the less-stringent tobacco
EverSmoke Make the switch today and live better.
regulations.14 How the product is marketed is
NJOY Cigarettes, you’ve met your match.
a primary consideration in determining its
Ashtrays are a thing of the past. intended use. The FDA opined that
Help a friend make the switch.
Tobacco doesn’t care. We do. consumers are particularly susceptible to
Au revoir, tobacco! confusion where products made or derived from
Fin A better alternative to cigarettes. tobacco that otherwise appear to be products
intended for recreational use make claims related
South Beach Smoke Make the switch today and change your life.
to quitting smoking.14(p57759)
V2 Don’t quit. Switch.
Break free from the pack.
The FDA announced its intent to scruti-
White Cloud It Works.
Quit kissing an ashtray. nize claims of cessation efficacy made by
e-cigarette brands by proposing regulations to
describe the
advertisements, 32 (13.5%) contained cessa- contained cessation messages of which 14 circumstances in which a product made or
tion messages, of which 9 (28.1%) were ex- (17.3%) were explicit and 67 (82.7%) implicit. derived from tobacco that is intended for human
plicit and 23 (71.9%) were implicit. Among Of the 408 Facebook posts that we analyzed, consumption will be subject to regulation as
536 advertisements by e-cigarette brands 78 (19.1%) contained cessation messages a drug, device, or a combination product under
the FD&C Act.14(p57756)
that produced both cigalike and APV devices, among which 21 (26.9%) were explicit and 57
142 (26.5%) of the advertisements contained (73.0%) implicit. Of the 384 tweets that we
In determining a product’s intended use,
a cessation theme, 29 (20.4%) of which considered, 38 (9.9%) contained cessation
the FDA
were explicit and 113 (79.6%) implicit. The messages, of which 14 (36.8%) were explicit
difference between cigalikes and APV ad- and 24 (63.1%) implicit. (Table 3). Supple- may take into account any claim or statement
vertisements is significant both in terms of the mentary claims on cessation-themed adver- made by or on behalf of a manufacturer that
frequency of cessation messages (P = .001) tisements are described in Table 4. explicitly or implicitly promotes a product for
a particular use.14(p57757)
and mix of explicit versus implicit message
types (P = .038). The 2015 FDA proposed rule includes the
Among the 328 blog posts that we sam- provision that a tobacco product may be
pled, 107 (32.6%) contained cessation claims, DISCUSSION regulated as a drug:
of which 6 (5.6%) were explicit and 101 It is generally accepted that e-cigarettes,
(94.4%) were implicit. Of the 203 testimo- which lack products of combustion, are If the product is intended to affect the structure
nials hosted on brand Web sites, 81 (39.9%) likely safer than traditional cigarettes. From or the function of the body in any way that is

2060 Research Peer Reviewed Jackler et al. AJPH November 2016, Vol 106, No. 11

Note. To the vast majority of consumers, the euphemistic phrase “Works for Me” is the logical equivalent of “our
product works to help you quit smoking.”
FIGURE 3—Implicit Smoking Cessation Claim in a Blu e-Cigarette (Imperial Tobacco
Company) Magazine Advertisement
different from the effects of nicotine that were
commonly and legally claimed in the marketing
of cigarettes and smokeless tobacco products
prior to March 21, 2000.14(p57756)
The FDA cited examples of nicotine effect
that are permitted including “satisfaction, plea-
sure, enjoyment, and refreshment.”14(p57760)
The crux of the issue is whether advertising
a tobacco product for its smoking-cessation
properties constitutes a therapeutic claim.
Cessation claims have been legally interpreted
to constitute a therapeutic intent. The FDA
November 2016, Vol 106, No. 11 AJPH
in 2015 stated: “. . . smoking cessation
claims on any product generally convey
the strong suggestion of therapeutic
benefit.”14(p57759)
A 2010 legal decision ruled that the FDA
lacked jurisdiction over e-cigarettes absent
therapeutic claim.20 Given this boundary,
only a minority of e-cigarette brands today
are explicit in their assertions of cessation
efficacy in the literal sense by stating “use this
product to quit smoking” or similar phrase-
ology. Instead, they employ a wide array
AJPH RESEARCH
of euphemistic phrases such as “alternative,”
“switch,” and “instead,” which are un-
ambiguous to consumers in their convey-
ance of a cessation message. In our study,
among the 23.0% of e-cigarette advertisements
that had cessation claims, more than 8 in 10
were communicated via implicit messaging. It
is important to note that the FDA proposed
rule of 2015 specifically encompasses both
“explicit or implicit” promotional claims.
Advertisers of e-cigarettes have proven to
be exceptionally creative in conveying ces-
sation messages. All but 1 of the 23 e-cigarette
brands analyzed included cessation messages
in their advertising. Terms such as “switch”
and “alternative” may logically appear to
be explicit cessation claims. However,
when not coupled with words or images
specifying the intent to change from smoking
traditional cigarettes, the terms possess a de-
gree of ambiguity. Although the terms may
have unambiguous meaning to consumers,
industry legal representatives could use this
ambiguity in defense against regulatory en-
forcement. Lindblom has contributed an
excellent review of First Amendment con-
siderations in regulating e-cigarette advertis-
ing.21 Some advertising variants use slogans
such as “Why Quit” and “Don’t Quit”—
which are the logical equivalent to “quit your
regular cigarettes and use our e-cigarettes
instead” (Figure I, available as a supplement to
the online version of this article at http://
www.ajph.org). Another technique is to use
a phrase such as “It Works,” which logically
can have no other credible meaning than it
works as a smoking cessation device (Figure I).
“Plan A, Plan B” is another unmistakable
euphemism (Figure E, available as a supple-
ment to the online version of this article
at http://www.ajph.org). Imagery is also
frequently used, such as advertising that in-
cludes illustrations of broken or snuffed-out
cigarettes (Figures B and C, available as
supplements to the online version of this
article at http://www.ajph.org). The SRITA
collection has more than 370 examples
that illustrate the implicit and explicit ad-
vertising avenues used by e-cigarette
brands to advertise cessation efficacy.22
Cessation-themed advertising is targeted
preferentially to recruit adult smokers. The 2
social media channels chosen for this study
have sizable adult user bases. In 2014, 58% of
US adults used Facebook, and 19% used
Jackler et al. Peer Reviewed Research 2061
AJPH RESEARCH

TABLE 2—Advertisements Containing Cessation Claims Made by e-Cigarette Brands on their

their preacquisition marketing practice,
Web Sites and Social Media Channels: January–June 2015 including cessation themes. The FDA-
proposed rules consider effects of nicotine
Product Advertisements, No. Cessation Claims, No. (%) Explicit/Implicit, No. as “customarily marketed” before 2000 to
be permissible.14 In the SRITA collec-
Blu 171 13 (7.6) 0/13
tion of tobacco advertisements, we are
NJOY 6 3 (50.0) 0/3
unaware of any combustible cigarette ad-
Fin 10 2 (20.0) 1/1 vertisements that either explicitly or im-
Vapor Fi 77 14 (27.3) 9/5 plicitly convey a smoking-cessation
Apollo 29 5 (24.1) 1/4 message.26 Indeed, it would be illogical for
tobacco companies to market such a prop-
White Cloud 260 71 (31.9) 15/56
osition as it would be contrary to their
Krave 14 4 (28.6) 0/4
business interest.
Mistic 39 11 (30.8) 1/10 To date, there are only a few studies of
EverSmoke 45 28 (71.1) 1/27 e-cigarette brand claims of cessation efficacy,
Starfire 15 4 (33.3) 1/3 principally focused upon brand Web sites.
A study of 2011 online advertising found that
Metro 50 12 (30.0) 0/12
64% of 59 e-cigarette brand Web sites in-
Nuvo 36 19 (44.4) 4/15
cluded a claim of cessation efficacy.10 A study
V2 42 8 (19.0) 0/8 of 2012–2013 online e-cigarette banner
White Rhino 27 2 (7.4) 1/1 and video advertisements found that 21% of
South Beach 64 26 (42.2) 1/25 the advertisements promoted cessation effi-
cacy.13 A 2012–2014 study of e-cigarette
Aspire 36 1 (2.7) 0/1
Web sites showed that the top-5 brands
Innokin 49 20 (40.8) 9/11 had no explicit cessation claims, but they
Veppo 43 25 (62.8) 10/15 appeared in 10.2% of the broader market
Volcano 152 24 (15.8) 1/23 brands.27 By contrast, implicit cessation
Kangertech 30 0 0/0 claims appeared in approximately 60% of
both top-5 and broader market brands.
Faze 14 1 (7.1) 0/1
Our study expands on previous work by
Provape 108 10 (0.9) 0/10 inclusion of social media platforms popular
Joyetech 6 1 (16.7) 0/1 among adult smokers (Facebook, Twitter),
Total 1323 304 (23.0) 55/249 categorization of implicit and explicit cessa-
tion slogans and imagery, analysis of cessation
Twitter. Among Internet users, 71% of adults Not surprisingly, e-cigarette brands started claim frequency by advertising channel, in-
used Facebook.23 Our study found that ces- by major tobacco purveyors with highly clusion of hyperlinks to promote cessation,
sation advertisements often carry health re- profitable businesses in combustible to- and a comparison of cigalike and APV ad-
assurance messages, also a predominantly bacco products, such as Vuse (RJ Reynolds) vertising practices. Limitations of this study
adult-targeted theme. Cessation messages and Mark Ten (Altria), do not employ include that we evaluated advertisements
seldom appear in youth-oriented advertise- smoking-cessation messages.24,25 Those from a 6-month period in the first half of
ments such as those promoting sweet or fruity e-cigarette brands acquired by major to- 2015 and advertising practices of e-cigarettes
flavors. bacco companies (e.g., Blu) may continue are under constant evolution. Although
the 23 leading brands we studied represent
a substantial fraction of sales, the full market
TABLE 3—Prevalence of e-Cigarette Cessation Claims by Brands through their Online includes hundreds of e-cigarette brands.
Channels: January–June 2015
Arguments exist in favor of allowing
cessation claims in e-cigarettes. First and
Channel Advertisements, No. Cessation Advertisements, No. Explicit/Implicit Claims, No.
foremost, cessation of combustible tobacco
Blog 328 107 6/101 use is a desirable outcome. Whereas much
Testimoniala 203 81 14/67 e-cigarette advertising highlights product
Facebook 408 78 21/57 features (e.g., sweet flavors) or messaging
Twitter 384 38 14/24
(e.g., sexual themes) of differential appeal
to youths, the cessation theme is clearly
Total 1323 304 55/249
more oriented to the adult smoker. Hence,
a
Testimonials appearing in brand-sponsored Web sites. cessation-themed advertisements may be less

2062 Research Peer Reviewed Jackler et al. AJPH November 2016, Vol 106, No. 11

TABLE 4—Supplementary Messages
Appearing on Online Cessation
Advertisements: January–June 2015
Advertisements,
Message No.
Less harmful to health 93
Cleaner than combustible tobacco 80
Cheaper than tobacco 49
Increased ability to smoke anywhere 46
Similar routine or feeling as cigarettes 43
Social benefits or reduced social 38
pressure
Better than other e-cigarette brands 32
Short-term health benefitsa 23
Environmentally friendly 16
Increased control of experience 28
Long-term health benefitsb 21
Reduced withdrawal symptoms 19
Alleviates specific medical condition 5 5. Mackey TK, Miner A, Cuomo RE. Exploring the
No weight gain 3 and their advertising—and the First Amendment. Food
a Drug Alcohol Depend. 2015;156:97–103.
Short-term health (e.g., no smoker’s cough,
ability to breathe better, improved taste).
b exposure to electronic cigarette advertising on suscepti-
Long-term health (e.g., live longer, no risk of
cancer).
a factor in driving the rapid rise in youth use
and the concern that e-cigarettes are be-
coming a gateway to nicotine addiction.28
We believe that arguments against per-
mitting cessation claims in e-cigarette ad-
vertising are compelling. Given the present
state of e-cigarette technology, we advocate
that cessation claims, whether implicit or
explicit, should not be permitted. On the basis
of the state of the scientific knowledge today,
a claim of cessation efficacy for an e-cigarette
brand amounts to false advertising. It is
conceivable that future technical advances
and chemical modifications may achieve
nicotine delivery similar to combustible cig-
arettes. If and when a specific e-cigarette
brand can present data supporting its efficacy
as a cessation device, the product should be
subject to FDA regulation as a drug, device,
or combination product requiring prior
approval.
CONTRIBUTORS
R. K. Jackler and D. Ramamurthi conceptualized the
study and are its principal authors. The content analysis
instrument was principally developed by D. Ramamurthi
with input from the other authors. P. Gall coded ad-
vertisements and N. Ayoub assisted with data analysis.
November 2016, Vol 106, No. 11 AJPH
ACKNOWLEDGMENTS
The study was funded by Stanford Research Into the
Impact of Tobacco Advertising.
HUMAN PARTICIPANT PROTECTION
No protocol approval was needed for this study because
no human participants were involved.
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Jackler et al. Peer Reviewed Research 2063