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

> **NIH NIH R01** · YALE UNIVERSITY · 2021 · $83,351

## Abstract

PROJECT SUMMARY
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. The parent project uses 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.
Youth (ages 13-19, N=80) 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 tests 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 compares
MPFC response between warning labels about addictiveness versus chemical constituents. Aim 2 tests 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 compares the relative value of multiple measures –fMRI, eye tracking and surveys –to predict future e-
cigarette use in the next year. Aim 3 replicates and extends 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-cigarett...

## Key facts

- **NIH application ID:** 10436640
- **Project number:** 3R01DA046334-03S1
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** Kathleen A. GARRISON
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $83,351
- **Award type:** 3
- **Project period:** 2021-08-01 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10436640

## Citation

> US National Institutes of Health, RePORTER application 10436640, The impact of e-cigarette advertising and warning labels on e-cigarette use behavior in adolescents (3R01DA046334-03S1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10436640. Licensed CC0.

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