MULTI-CHANNEL MARKETING EXPOSURE AND PSYCHOACTIVE SUBSTANCE USE IN E-CIGARETTES: A CROSS-SECTIONAL STUDY OF POLISH ADOLESCENTS AND YOUNG ADULTS

Abstract

Objectives: The increasing prevalence of electronic cigarettes (e-cigarette) use among adolescents has raised concerns about potential high-risk behaviors, particularly the addition of psychoactive substances to e-cigarette liquid (e-liquids). This study examines the association between exposure to e-cigarette marketing and the practice of adding psychoactive substances to e-liquids among Polish teenagers. Material and Methods: A cross-sectional survey was conducted with 8344 Polish teenagers aged ≥15 years. The study evaluated exposure to various e-cigarette marketing channels, the prevalence of psychoactive substances added to e-liquids and associated demographic and socioeconomic factors. Results: Among participants, 7.15% reported adding psychoactive substances to e-liquids, with tetrahydrocannabinol being the most commonly reported substance. E-cigarette marketing exposure, especially in urban areas and via digital platforms, was significantly associated with an increased likelihood of adding psychoactive substances to e-liquids (p < 0.001). Higher-income adolescents exhibited greater susceptibility to this behavior when exposed to marketing. Maternal secondary education demonstrated a protective effect. Various marketing channels showed differential impacts, with club or social venue promotions demonstrating the strongest association with psychoactive substance use. Conclusions: These findings elucidate the complex interplay between e-cigarette marketing exposure, socioeconomic factors, and high-risk e-cigarette use among adolescents. The results underscore the necessity for more stringent regulation of e-cigarette marketing and comprehensive, targeted prevention strategies focusing on urban and higher-income youth populations. Int J Occup Med Environ Health. 2025;38(2):190–206