The impact of e-cigarette advertising and warning labels on e-cigarette use behavior in adolescents

摘要 电子烟现在是美国年轻人使用的最常见的烟草产品。主要原因之一 年轻人尝试电子烟的报告是低风险的看法和吸引人的口味。青年有穷 了解电子烟的健康风险，直到最近才要求警告标签。与此同时，e- 香烟的广告中有甜味和水果味，以增加对年轻人的吸引力。我们最近的一项研究表明， 研究小组指出，这些因素也相互作用-电子烟广告中的甜味/水果味图像 让年轻人远离警告标签为了更好地了解这些因素如何影响年轻人使用电子烟， 迫切需要采取措施，将接触电子烟广告和警告标签与未来的电子烟联系起来， 吸烟行为功能性磁共振成像（fMRI）已被用于识别大脑活动 预测未来健康行为的模式，包括自我报告以外的烟草使用。多项fMRI研究 研究表明，内侧前额叶皮层（MPFC）对香烟警告的反应可以预测未来的吸烟行为。 其他功能磁共振成像研究表明，对广告的反应预测了 purchasing.该项目将使用类似的大脑预测方法，结合功能磁共振成像和眼动跟踪， 对电子烟广告的反应以及对青少年未来电子烟使用行为的警告标签。 青少年（14 - 17岁，N = 80）将在fMRI中查看电子烟广告和警告标签，并完成 每季度进行一次后续调查，为期一年。MPFC和NAc活动将被测量和测试的关系 未来电子烟的态度，意图和使用。额外的功能磁共振成像控制条件将允许我们测试 不同类别的警告标签和不同的电子烟口味的具体影响，以及相互作用 这些因素之间的关系，包括它们对警告标签记忆的影响。目标1将检验以下假设： 更大的MPFC活动，因为青少年认为电子烟警告标签将与更负面的电子烟有关， 吸烟态度和意图以及明年电子烟的使用量减少。探索性目标1.1将 比较MPFC对成瘾性警告标签与化学成分的反应。目标2将 测试假设，即青少年观看电子烟广告时更大的NAc活动将与 更积极的电子烟态度和意图，以及明年更多地使用电子烟。探索性 目标2.1将比较多种测量方法的相对值-功能磁共振成像，眼动跟踪和调查-以预测未来 明年电子烟的使用。Aim 3将通过测试是否有图像来复制和扩展我们最近的研究， 电子烟广告上的味道分散了青少年对警告标签的注意力。总的来说，这个项目应该 就电子烟广告和警告标签对电子烟使用的影响提供关键证据 行为，并告知FDA努力规范电子烟口味，标签和营销。重要 还将生成关于多种措施的相对价值的信息，以预测未来的电子烟使用。

ABSTRACT E-cigarettes are now the most common tobacco product used by youth in the US. Among the primary reasons youth report for having tried e-cigarettes are low risk perceptions and appealing flavors. Youth have poor knowledge of e-cigarette health risks, which only recently have a required warning label. At the same time, e- cigarettes are advertised in sweet and fruit flavors that increase their appeal to youth. A recent study by our team indicated that these factors also interact –images of sweet/fruit flavors on e-cigarette advertisements distracted youth from warning labels. To better understand how these factors impact e-cigarette use by youth, there is a critical need for measures linking exposure to e-cigarette advertising and warning labels to future e- cigarette use behavior. Functional magnetic resonance imaging (fMRI) has been used to identify brain activity patterns that predict future health behavior including tobacco use beyond self-report. Multiple fMRI studies indicate that the medial prefrontal cortex (MPFC) response to cigarette warnings predicts future smoking. Other fMRI studies indicate that the nucleus accumbens (NAc) response to advertisements predicts purchasing. This project will use a similar brain-as-predictor approach with fMRI and eye tracking to link neural responses to e-cigarette advertising and warning labels to future e-cigarette use behavior in youth. Adolescents (ages 14-17, N=80) will view e-cigarette advertisements and warning labels in fMRI and complete quarterly follow-up surveys for one year. MPFC and NAc activity will be measured and tested for relationships with future e-cigarette attitudes, intentions and use. Additional fMRI control conditions will allow us to test the specific impact of different categories of warning labels and different e-cigarette flavors, and the interactions between these factors, including their impact on memory for warning labels. Aim 1 will test the hypothesis that greater MPFC activity as adolescents view e-cigarette warning labels will be related to more negative e- cigarette attitudes and intentions and lower use of e-cigarettes in the next year. Exploratory Aim 1.1 will compare MPFC response between warning labels about addictiveness versus chemical constituents. Aim 2 will test the hypothesis that greater NAc activity as adolescents view e-cigarette advertisements will be related to more positive e-cigarette attitudes and intentions and greater use of e-cigarettes in the next year. Exploratory Aim 2.1 will compare the relative value of multiple measures –fMRI, eye tracking and surveys –to predict future e-cigarette use in the next year. Aim 3 will replicate and extend our recent study by testing whether images of flavors on e-cigarette advertisements distract adolescents from warning labels. Overall, this project should generate critical evidence on the impact of e-cigarette advertising and warning labels on e-cigarette use behavior in youth, and inform FDA efforts to regulate e-cigarette flavors, labeling and marketing. Important information will also be generated on the relative value of multiple measures to predict future e-cigarette use.