Dr. Halpern-Felsher

Are Kids Who Own Tobacco Promotional Materials More Likely To Start Products Like Juul?

MedicalResearch.com Interview with:
Bonnie Halpern-Felsher, PhD, FSAHM

Dr. Halpern-Felsher

Professor of Pediatrics
Director of Fellowship Research
Department of Pediatrics
Director of Research, Division of Adolescent Medicine
Associate Director, Adolescent Medicine Fellowship Program
Co-leader, Scholarly Concentrations,
Pediatrics Residency Program
Stanford University

Hoda S. Abdel Magid, MHS, PhDPostdoctoral ScholarDepartment of Health Research & PolicyStanford UniversityHoda S. Abdel Magid, MHS, PhD
Postdoctoral Scholar
Department of Health Research & Policy
Stanford University

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Dr. Hoda Magid, my former graduate student, and I wanted to examine whether owning promotional items for e-cigarettes and other non-cigarette products predicted youth use of those products.  Other studies have examined whether ownership of coupons, samples, and other promotional materials influenced cigarette use, but no longitudinal study examined other tobacco products.

Our findings show that non-tobacco using youth who own items to promote e-cigarettes and other alternative tobacco products are twice as likely to use alternative tobacco products a year later.

MedicalResearch.com: What should readers take away from your report? 

Response: The findings are important for regulation.  Currently, marketing to minors and providing free samples of a product is illegal.  However, providing coupons and branded promotional items such as t-shirts and hats is only prohibited for smokeless tobacco.  Our findings clearly show that such promotional products need to be illegal for all tobacco products, in order to help prevent youth use. Specifically, our study suggests that the current marketing restrictions for cigarettes such as restrictions on the distribution of all promotional materials for cigarettes should extend to e-cigarettes and other non-cigarette products. Further, our findings show that FDA and other enforcement agencies need to enforce existing laws prohibiting promotion of tobacco to youth.

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: We need more studies with larger samples that are able to focus on promotional items of specific products, such as Juul.  This would provide more detailed information.  However, our study’s findings still clearly show the importance of regulating all materials for all tobacco products. 

MedicalResearch.com: Is there anything else you would like to add?

Response: The problem is that the FDA has been very slow to enact new or enforce existing laws and regulations for e-cigarettes. Right now, the FDA is not going after manufacturers who have not put in an application to market e-cigarettes. The Family Smoking Prevention and Tobacco Control Act requires all tobacco companies to submit premarket applications to FDA and receive agency authorization before putting a product on the market, but the compliance dates have been extended to 2021 or 2022, depending on the product. This means thousands of e-cigarettes and other alternative tobacco products are being marketed without any FDA review.

No disclosures.


Abdel Magid HS, Bradshaw PT, Ling PM, Halpern-Felsher B. Association of Alternative Tobacco Product Initiation With Ownership of Tobacco Promotional Materials Among Adolescents and Young Adults. JAMA Netw Open. 2019;2(5):e194006. doi:10.1001/jamanetworkopen.2019.4006

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Last Updated on May 19, 2019 by Marie Benz MD FAAD