The Q&A: Maria Cooper

With each issue, Trib+Health brings you an interview with experts on issues related to health care. Here is this week's subject:

Maria Cooper is a postdoctoral fellow at the Tobacco Center of Regulatory Science on Youth and Young Adults at the University of Texas Health Science Center at Houston. She was involved in a study that looked at e-cigarette marketing and use among young people.

Editor's note: This interview has been edited for length and clarity.

Trib+Health: Could you give me a broad study of what the study was about and what the most interesting findings were?

Maria Cooper: The purpose of this study was to look at how exposure to e-cigarette marketing among youth was linked to using e-cigarettes. We know that this is important because e-cigarettes are the mostly commonly used tobacco product among youth, so they’re more common than cigarettes. And know that marketing for these products, the marketing funding has been increasing in conjunction with this increase in use.

So we wanted to see, are these things linked to each other? We also know that marketing for e-cigarettes isn’t regulated in the same way that it’s regulated for traditional cigarettes. For traditional cigarettes, there are certain bans on advertising in publications with high youth readership and bans on sponsoring sporting events or music events; but for e-cigarettes there are no marketing bans in the same way, so we know that they’re more highly unregulated. And we know that seven out of 10 youth report seeing e-cigarettes advertised in some way or another. That’s the background, and that was the concern for us.

Specifically, we looked at advertising in a national data set. This was the National Youth Tobacco Survey in 2014, and we looked at four different media — we looked at internet, print advertising, retail, and TV and movies. We looked at whether or not youth reported seeing e-cigarettes advertised in any of those avenues and whether or not they reported using e-cigarettes. We found that for each medium there was a clear link between e-cigarette use and exposure to advertising. In addition to that, we saw an increasingly stronger relationship with e-cigarette use and a cumulative exposure — so the more sources they were exposed to, the higher the odds of using e-cigarettes were.

Trib+Health: What are the potential policy implications of those findings?

Cooper: For policy in Texas, last year we passed a statewide ban to limit sales of e-cigarettes to youth, so that was good. The FDA recently passed a rule to regulate e-cigarettes and to restrict sales of e-cigarettes to youth nationwide, so we think these are good first steps, but we think that there is more to be done. These bans, both in Texas and the nationwide ruling, didn’t include any regulations on marketing, they didn’t include regulations on e-cigarette flavoring, and we think these are things that are especially concerning for youth who are using these products more frequently. We think that further regulation would help to deter use among young people.

Trib+Health: Were you surprised by any of the findings?

Cooper: It seems logically to make sense to us. We know that both of these numbers were increasing — we knew there was an increase in use and we knew there was an increase in marketing, going up in conjunction. So what the study showed us that they certainly were linked.

However, in research terms, we would call it a cross-sectional study, meaning that we only had one point in time. There’s still further work to be done to see the temporal relationship — which comes first, is it that marketing leads to e-cigarette use or is it that e-cigarette use leads to people noticing marketing more? We couldn’t answer that question specifically with this study, so there’s still research to be done to understand the relationship more clearly.