"It’s the Wild West out there when it comes to e-cigarette advertising," said Tom Frieden, director of the Centers for Disease Control and Prevention, which released the data. "It's no coincidence that as the advertising has skyrocketed, the use of e-cigarettes has skyrocketed."
CDC's findings were drawn from the 2014 National Youth Tobacco Survey, which included a representative sample of more than 22,000 middle and high school students. Nearly 70 percent -- an estimated 18.3 million students -- reported having seen e-cigarette marketing in at least one setting that year. They were most likely to see e-cig ads in retail stores, followed by the internet, television, movies, newspapers and magazines. Young people reported seeing more ads for conventional cigarettes and other tobacco products in retails stores than for e-cigarettes, but the level of exposure in other venues was comparable.
Anti-smoking advocates and public health officials say advertising for conventional tobacco products such as cigarettes triggers increased experimentation among young people, leading to more smokers. They worry the same scenario is playing out with e-cigarettes, which currently don't face the advertising restrictions that apply to traditional cigarettes. That's bad news, they say, because of evidence that nicotine use can negatively affect the developing brains of teenagers, because so much remains unknown about the long-term effects of e-cigarettes and because of the potential that young people who try them could wind up as regular smokers.
"This is a problem," Frieden said. "Whatever you think about adult use of e-cigarettes, kids should not be using e-cigarettes."
Tuesday's report comes as the e-cigarette industry continues to flourish in the United States. Sales have grown exponentially, hitting an estimated $2.5 billion in 2015. Researchers say e-cigarette advertising has grown along with the market, from an estimated $6.4 million in 2011 to an estimated $115 million in 2014.
While manufacturers insist their products are aimed at solely at adults -- in many cases, smokers looking for a way to satisfy their nicotine cravings while avoiding the well-documented harm of tobacco -- the devices have become increasingly popular among young people. CDC reported last year that the number of middle and high school students using e-cigarettes tripled from 2013 to 2014, eclipsing their use of traditional cigarettes.
In 2014, the Food and Drug Administration announced plans to begin regulating e-cigarettes for the first time. The agency said it planned to force manufacturers to curb sales to minors, stop handing out free samples, place health warning labels on their products and disclose the ingredients. Makers of e-cigarettes also would be banned from making health-related claims without scientific evidence. However, the proposal stopped short of seeking restrictions on online sales of e-cigarettes or television advertising. And 18 months later, the FDA still has not finalized any of those new regulations.
Cynthia Cabrera, executive director of the Smoke-Free Alternatives Trade Association, an industry group, said that just because young people encounter e-cigarette ads doesn't mean the products are targeted toward minors.
"If you showed me [e-cigarette] ads on Nickelodeon or the Cartoon Network, at the Lego store or in Toys 'R' Us, then I'd say you have a legitimate gripe," Cabrera said. Those ads generally appear on channels such as Comedy Central, which primarily target adults but attract young viewers as well. "They are putting their advertising in places where the demographic meets that of the adult vaper."
Cabrera cited a series of high-profile ads for Blu e-cigarettes that featured model and actress Jenny McCarthy, who is 43. "Why would anyone use a 40-something-year-old woman to try to hook 17-year-old boys?" she said. "They chose someone well into their 40s to do the ad, because that's their demographic."
She also noted that most states already have age restrictions to keep e-cigarettes out of the hands of minors. Health officials should be highlighting the sharp drop in traditional cigarette smoking among young people, she said, and not demonize e-cigarettes, which are widely believed to be less harmful when used in the place of other tobacco products.
But Matthew Myers, president of the Campaign for Tobacco-Free Kids, said the latest data should give the Obama administration renewed urgency to begin overseeing the booming e-cigarette industry. In particular, Myers cited the report finding that more than half of all sixth-graders have seen e-cigarette ads in a retail store and more than a third have seen such ads on the internet.
Companies "are getting to them early, long before they become teenagers," he said. "It was the case with cigarettes 25 years ago. They are using the same themes and the same images [as tobacco]. But the penetration in the modern media era is as strong as anything we’ve ever seen."