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M. Jane Lewis, DrPH, Cristine D. Delnevo, PhD, MPH and John Slade, MD

M. Jane Lewis and Cristine D. Delnevo are with the Division of Health Education and Behavioral Science, University of Medicine and Dentistry of New Jersey—School of Public Health, Piscataway, NJ. At the time of the research, John Slade was also with the UMDNJ-SPH.

Correspondence: Requests for reprints should be sent to M. Jane Lewis, DrPH, UMDNJ—School of Public Health, 683 Hoes Ln W, 3rd Fl, PO Box 9, Piscataway, NJ 08865 (e-mail: lewismj{at}umdnj.edu; delnevo{at}umdnj.edu).

	ABSTRACT

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We examined adult participation in tobacco industry direct marketing: receipt of direct mail and use of coupons and brand reward programs. Participation was highest for direct mail; participation in all 3 forms differed by gender, age, and race/ethnicity; current smokers, Whites, and persons aged 25 to 64 years reported greater participation. Although tobacco industry direct marketing may influence smoking initiation, its potential to increase consumption and impede cessation is unquestionable.

	INTRODUCTION

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Tobacco industry marketing has been shown to affect smoking initiation and consumption.^1–3 In recent years, tobacco marketing has shifted from a focus on traditional advertising to increasing use of techniques emphasizing developing and maintaining relationships with individual customers.^4,5 Direct marketing, or direct communication with consumers with the goal of making a sale or generating another measurable response, is one of these techniques.⁶

A major element of direct marketing is direct mail targeted to individuals on tobacco companies’ extensive mailing lists. Direct mail is a major distribution channel for coupons, sweepstakes offers, brand-loyalty program catalogs (e.g., Camel Cash, Marlboro Miles), industry-sponsored event announcements, and magazines published by tobacco companies. As with all tobacco promotions, these items feature images and activities designed to be emotionally appealing to consumers and to reinforce brand images.⁵ Names for these lists are obtained in different ways, including at industry-sponsored events (e.g., bar/club promotions) and from sweepstakes forms, signed coupons, and brand-loyalty program orders. Mailings usually feature a response mechanism providing information for future marketing efforts, such as a survey asking cigarette or lifestyle preferences or coded coupons identifying which respondents redeemed them.

Use of direct mail has been increasing. The 6 major US cigarette manufacturers spent $133.9 million on direct mail in 2001, a 131.8% increase from 1998.⁷ This does not include costs for direct mail containing coupons or specialty items distributed by mail; actual direct mail expenditures are unclear and likely much higher.

	METHODS

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Tobacco industry direct marketing has been studied primarily through content analysis of industry documents and other materials.^4,8,9 To our knowledge, this article presents the first examination of population-based data on adult participation in tobacco industry direct mail marketing. We examined data from the 2001 New Jersey Adult Tobacco Survey, a point-in-time survey regarding tobacco use behavior, knowledge, and attitudes.¹⁰ In brief, a random-digit-dial design was utilized, oversampling for certain groups (e.g., smokers); 3900 adults participated. The data set was weighted to address nonresponse and varied probabilities of selection and was representative of New Jersey adults. The New Jersey Adult Tobacco Survey addresses several tobacco-related areas, including participation in industry promotional efforts. For this article, we examined data from 3 questions. We asked participants if they did any of the following within the past 6 months: received mail from a tobacco company, including coupons, magazines, or catalogs; used coupons to buy cigarettes; and saved UPC codes, Camel Cash, Marlboro Miles, or tokens from any other brand-loyalty programs. Logistic regression, conducted with SUDAAN,¹¹ generated an adjusted odds ratio for each variable; this controlled for smoking status, gender, race/ethnicity, and age group.

	RESULTS

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Current smokers were 4.5 times more likely than never/former smokers to report receiving direct mail within the past 6 months (Table 1). Recent quitters (quit during the past 12 months) were also 2.4 times more likely to receive direct mail than never/former smokers. The likelihood of receiving direct mail was significantly higher for White adults. Using coupons to purchase cigarettes was higher among females, White adults, and those aged between 25 and 64 years. Saving for brand-reward programs was higher among current smokers, Whites, and 18- to 24-year-olds.

	DISCUSSION

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In a time when tobacco control portrays smoking as a dangerous addictive behavior with serious health effects, direct mail and its messages provide smokers with inviting images of and rewards for smoking.⁵ Furthermore, communicating directly with consumers not only passes under the public health community’s radar screen but also bypasses growing restrictions on traditional advertising. Indeed, a 1995 Philip Morris direct marketing plan notes this as 1 factor influencing interest in its use.¹⁵

Participation in and industry expenditures on direct mail and other direct marketing techniques are expected to continue growing in the future. Although direct mail is one of many tobacco industry tactics accounting for a small proportion of total advertising and promotional spending,⁷ it is worthy of concern, especially given the industry’s track record of identifying and employing successful marketing strategies and shifting strategies in response to regulation and public opinion. Furthermore, no tobacco industry marketing strategy stands alone; all are designed to work together to encourage initiation and consumption. Tobacco control efforts cannot succeed unless we understand all components of the industry’s marketing programs.¹⁶ This requires awareness of these alternative marketing tactics (see examples at www.trinketsandtrash.org) and requires efforts to reduce their impact, including exposing their probable intent and possible effect. In addition, as much as smokers who want to quit are advised to remove triggers (e.g., ashtrays) from their environment,¹⁷ they also should be encouraged to remove their names from industry mailing lists.

	Acknowledgments

 
This work was partially supported by a contract from the New Jersey Department of Health and Senior Services, through funding from the Master Settlement Agreement.

We thank Raychel Adler, Mary Hrywna, Mona Shah, and Spiro Yulis for their comments on drafts and Ed Malka for assistance with the analysis. This article is dedicated to the memory of our colleague and coauthor, John Slade.

Human Participant Protection
This study was approved by the institutional review board of the University of Medicine and Dentistry of New Jersey—Robert Wood Johnson Medical School (institutional review board reference W-0616) and was considered exempt by the institutional review board of the New Jersey Department of Health and Senior Services.

	Footnotes

 
Contributors
M. J. Lewis formulated the concept for the brief, interpreted the findings, and led the writing. C. D. Delnevo developed and implemented the analysis plan, contributed to drafts, and helped interpret findings. J. Slade contributed content expertise and inspiration.

Peer Reviewed

Accepted for publication July 18, 2003.

	References

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2. Biener L, Siegel M. Tobacco marketing and adolescent smoking: more support for a causal inference. Am J Public Health. 2000;90:407–411.[Abstract/Free Full Text]

3. Saffer H, Chaloupka F. Tobacco Advertising: Economic Theory and International Evidence. Cambridge, Mass: National Bureau of Economic Research; 1999. Working Paper 6958.

4. Anderson S, Hastings G, MacFadyen L. Strategic marketing in the UK tobacco industry. Lancet Oncol. 2002;3:481–486.[ISI][Medline]

5. Slade J. Marketing policies. In: Rabin RL, Sugarman SD, eds. Regulating Tobacco. New York: Oxford University Press; 2001:72–110.

6. Lewis BR, Littler D, eds. The Blackwell Encyclopedic Dictionary of Marketing. Malden, Mass: Blackwell Publishers; 1999:185–186.

7. US Federal Trade Commission. 2000 report on cigarette sales, advertising and promotion. Available at: http://www.ftc.gov/os/2002/05/2002cigrpt.pdf. Accessed November 5, 2002.

8. Sepe E, Ling PM, Glantz SA. Smooth moves: bar and nightclub tobacco promotions that target young adults. Am J Public Health. 2002;92:414–419.[Abstract/Free Full Text]

9. Katz SK, Lavacck AM. Tobacco related bar promotions: insights from tobacco industry documents. Tob Control. 2002;11:92–101.[Free Full Text]

10. University of Medicine and Dentistry of New Jersey. 2001 New Jersey Adult Tobacco Survey. New Brunswick, NJ: School of Public Health; 2002.

11. SUDAAN User’s Manual, Release 8.0. Research Triangle Park, NC: Research Triangle Institute; 2001.

12. Chaloupka FJ, Cummings KM, Morley CP, Horan JK. Tax, price and cigarette smoking: evidence from the tobacco documents and implications for tobacco company marketing strategies. Tob Control. 2002;11(suppl I):i62–i72.[Abstract/Free Full Text]

13. Chaloupka F, Slater S, Wakefield M. USA: price cuts and point of sale ads follow tax rise. Tob Control. 1999;8:242.[Free Full Text]

14. Imber J, Toffler BA, eds. Dictionary of Marketing Terms. 3rd ed. Hauppauge, NY: Barron’s Educational Series; 2000:332.

15. 1995 Strategic Plan: Database Development & Direct Marketing. Philip Morris Tobacco Company February 1995. Bates No. 2043338051/8081. Available at: http://legacy.library.ucsf.edu. Accessed June 12, 2001.

16. King C, Siegel M. The master settlement agreement with the tobacco industry and cigarette advertising in magazines. N Engl J Med. 2001;345:504–511.[Abstract/Free Full Text]

17. Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, Md: US Department of Health and Human Services, Public Health Service; 2000.

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This Article Abstract Full Text (PDF) Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Lewis, M. J. Articles by Slade, J. Search for Related Content PubMed PubMed Citation Articles by Lewis, M. J. Articles by Slade, J. Related Collections Tobacco Control Surveillance Surveys Other Tobacco