Changes in Tobacco-related Advertising for Adolescents Between 2017-18 and 2019-20: Results From the California Student Tobacco Survey.

PurposeThe media environment is a key structural factor that influences population knowledge, attitudes, norms, and health behaviors. This study examined changes in tobacco-related advertising for adolescents in California between 2017-18 and 2019-20, a period of significant advertising activities both promoting and discouraging tobacco use, from the tobacco industry and public health authorities, respectively.DesignRepeated cross-sectional study.SettingCalifornia Student Tobacco Survey in 2017-18 and 2019-20.SubjectsEighth, 10th, and 12th grade students (138 528 in 2017-18 and 160 350 in 2019-20).MeasuresSelf-report of exposure to and perception of whether advertisements mostly encouraged (pro) or discouraged (anti) vaping [or smoking].AnalysisWeighted percentages of ad exposure and ratios of anti-over-pro ads in 2017-18 and 2019-20 were compared.ResultsThe proportion of students reporting vape-related advertisement exposure increased from 42.2% in 2017-18 to 67.1% in 2019-20 (P < .001); those reporting cigarette-related advertisement exposure decreased (from 64.6% to 51.2%, P < .001). The ratio of anti-over-pro advertisement perception for vapes increased (from 1.43 to 2.28, P < .001) and the ratio for cigarettes decreased (from 3.75 to 2.55, P < .001).ConclusionsAdvertising activities from both the tobacco industry and public health authorities have reached adolescents. Adolescents' overall perception was that the tobacco-related media environment, while being generally anti-tobacco, had become more anti-vaping and less anti-smoking. The effects of these advertisements on tobacco use behaviors merit further investigation.