Research suggests that exposure to cartoon-based advertisements for e-cigarettes is related to greater potential for young adults to use the products in the future.

Like the infamous "Joe Camel" advertisements for cigarettes in the 1980s and 90s, the use of cartoon characters in ads for e-cigarettes and e-liquids may be attracting young people to the nicotine-delivery products, according to a new USC study.

The newly published research, which also found that recognition of the cartoon images among those who had never used e-cigarettes was positively associated with expectations that the products would taste good and enhance socializing, appears in Drug and Alcohol Dependence.

"Among young adults who had never used e-cigarettes, we found a significant effect of cartoon-based marketing on their likelihood of using the products in the future," said Jon-Patrick Allem, co-leader of the study and assistant professor of research at the Keck School of Medicine of USC. "Cartoons appear to be very effective at increasing susceptibility to use e-cigarettes among individuals who aren't using them to begin with."

The relationship between cartoon recognition and likelihood of e-cigarette use

Study authors looked at two different sets of young adults who completed online surveys assessing e-cigarette use. In the first study, 778 participants with an average age of 24 years looked at several e-liquid package images with and without cartoons and were asked whether they recognized the products. In the second study, 522 participants with an average age of 30 looked at several e-liquid images with and without cartoons and rated the appeal of the products.

Among self-reported "never users" of the products, individuals who recognized the cartoons were more likely to be susceptible to future use.

Matt Kirkpatrick, co-leader of the study and assistant professor of research at the Keck School, added that cartoons are being used to market the products in two distinct ways: as logos by e-cigarette and e-liquid companies and in promotional materials by vendors that sell the products online -- including via Instagram and Twitter -- or offline. "Cartoon imagery used by some companies are part of the constellation of variables that make individuals susceptible to future use of e-cigarettes," Kirkpatrick said.

Building on prior research into cartoons and young adults' tobacco use

The findings are consistent with previous studies demonstrating the impact of cartoon-based marketing on cigarettes, unhealthy foods and other products.

Prior research indicated that Joe Camel, a cartoon character developed by RJ Reynolds as a mascot for its brand, increased awareness and appeal of -- as well as uptake and continued use of -- combustible cigarettes. One study published in JAMA in 1991 famously demonstrated that preschool children recognized "Joe" as easily as they recognized Disney's Mickey Mouse.

The USC researchers say their study builds on this work by analyzing cartoon-based marketing for emerging tobacco products among an at-risk population: young adults. In their earlier research, Allem and Kirkpatrick found e-cigarette vendors were using Pokémon Go -- a cartoon-based augmented reality game -- to sell their products on Twitter. In a previous analysis of Instagram images posted by e-liquid manufacturers and vendors, they found 21% of posts contained a cartoon.

"The data in this most recent study suggest a need for policies to extend restrictions on cartoon-based marketing of cigarettes to include marketing for e-cigarettes," Allem said.

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Additional study authors include Tess Boley Cruz, Jennifer B. Unger, Josseline Herrera and Sara Schiff, all of the department of preventive medicine at the Keck School. The research was funded by grant #P50CA180905 from the National Cancer Institute and the FDA Center for Tobacco Products.