{
  "abstract": "Introduction Emerging nicotine-containing products, including heated tobacco products (HTPs) and nicotine pouches, have been growing in popularity in the European Union (EU). Advertising exposure impacts perceived product appeal and may contribute to product initiation. However, the current EU’s Tobacco Products Directive lacks a consistent framework for regulating these advertisements. This study examines how exposure to HTP and nicotine pouch advertisements influences their appeal among people who have never used nicotine.Methods Data from the Special Eurobarometer 99.3 survey (May–June 2023) included 13 436 participants who have never used nicotine across 27 EU Member States. We estimated the weighted prevalence of HTP and nicotine pouch advertising exposure and perceived appeal and ran multilevel Poisson regression models adjusting for sociodemographic factors.Results 31.1% of participants reported HTP advertising exposure across the EU, with the highest levels reported in Romania (53.4%) and Slovakia (50.0%) and the lowest in Malta (13.6%). Nicotine pouch advertising exposure averaged 16.6%, peaking in Sweden (46.0%) and lowest in the Netherlands (5.0%) and Lithuania (7.7%). Product appeal remained low, with only 2.0% finding HTPs appealing and 1.3% finding nicotine pouches appealing. Exposed to HTP advertisements were 3.71 times more likely to find them appealing, while exposure to nicotine pouch advertisements increased perceived appeal of nicotine pouches by 5.78 times.Conclusion Advertising exposure was associated with higher appeal of nicotine-containing products among people who have never used nicotine. Given the risk of initiation, EU-wide advertising restrictions could protect this group and limit the impact of these products on health.",
  "authors": [
    {
      "affiliations": [
        "Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK",
        "European Network for Smoking and Tobacco Prevention, Brussels, Belgium"
      ],
      "name": "Charlotte Xin Li"
    },
    {
      "affiliations": [
        "Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK"
      ],
      "name": "Pin-Chun Wang"
    },
    {
      "affiliations": [
        "Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK",
        "CIBER en Enfermedades Respiratorias (CIBERES), Madrid, Spain"
      ],
      "name": "Ariadna Feliu"
    },
    {
      "affiliations": [
        "Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK"
      ],
      "name": "Anthony A Laverty"
    },
    {
      "affiliations": [
        "CIBER en Enfermedades Respiratorias (CIBERES), Madrid, Spain",
        "Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain",
        "Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain",
        "Department of Public Health, Maternal Health and Mental Health, School of Nursing, L'Hospitalet del Llobregat (Barcelona), Universitat de Barcelona, Barcelona, Spain",
        "Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA"
      ],
      "name": "Cristina Martinez"
    },
    {
      "affiliations": [
        "Laboratory of Epidemiology, Hygiene and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece"
      ],
      "name": "Constantine I Vardavas"
    },
    {
      "affiliations": [
        "Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK"
      ],
      "name": "Filippos T Filippidis"
    }
  ],
  "title": "Advertising exposure and the appeal of emerging nicotine-containing products among people who have never used nicotine: findings from the Eurobarometer 2023",
  "uid": "532e18e8-a994-527e-bb8c-5302aa960e80"
}