标题：Frequency and Characteristics Associated With Exposure to Tobacco Direct Mail Marketing and Its Prospective Effect on Smoking Behaviors Among Young Adults From the US Midwest
摘要：Objectives. We examined the exposure to tobacco direct mail marketing and its effect on subsequent smoking behaviors in a US Midwest regional cohort of young adults. Methods. Data were collected from 2622 young adults (mean age = 24 years) in 2010 to 2011 (baseline) and 2011 to 2012 (follow-up). We collected information on demographics, tobacco use, and exposure to tobacco direct mail materials in the previous 6 months at baseline. Smoking behaviors were reassessed at follow-up. We investigated the characteristics associated with receiving these materials at baseline, and the associations between receiving cigarette coupons in the mail at baseline and smoking behaviors at follow-up. Results. Thirteen percent of participants reported receiving tobacco direct mail materials in the previous 6 months. Receipt of these materials was associated with age, education, and tobacco use ( P < .05). Among those who received these materials, 77% and 56% reported receiving coupons for cigarettes and other tobacco products, respectively. Among baseline nonsmokers and ex-smokers, receiving coupons was associated with becoming current smokers at follow-up ( P < .05). Among baseline current smokers, receiving coupons was associated with lower likelihood of smoking cessation at follow-up ( P < .05). Conclusions. Tobacco direct mail marketing promoted and sustained smoking behaviors among US Midwest young adults. Regulating this marketing strategy might reduce the prevalence of smoking in this population. It has been 50 years since the first Surgeon General’s report on smoking and health released in 1964. Since then, more than 20 million people in the United States have died because of smoking. 1 Smoking remains an important public health problem today. Currently, more than 480 000 deaths in the United States annually are attributed to smoking. 1 Smoking is particularly prevalent among young adults: 31.8% of young adults (aged 18–25 years) were current smokers in 2012, compared with 22.0% in the overall adult population (aged ≥ 18 years). 1 Additionally, more than 50% of those who ever smoked daily reported starting daily smoking between the ages of 18 and 30 years. 1 This indicates that these 12 years represent a critical period for developing smoking behaviors, and understanding factors that promote smoking behavior during this period might inform interventions to reduce the prevalence of smoking in the population. Tobacco marketing is one of the factors that promote smoking, particularly among youths. 2–4 However, few studies have examined exposure to tobacco direct mail marketing and its effects on smoking behaviors among young adults. One study reported data from the New Jersey Adult Tobacco Survey 2001 (participants aged ≥ 18 years), which found that 11% of never or former smokers, 22% of recent quitters, and 35% of current smokers reported receiving direct mail materials from a tobacco companies in the previous 6 months. 5 However, the cross-sectional design of the survey did not allow investigation of the effect of receiving these materials on subsequent smoking behaviors. We previously published the first longitudinal study in the United States examining the exposure to tobacco direct mail marketing in a cohort of adolescents and young adults from the US Midwest region. 6 We found that 11% of 18- to 23-year-old participants (6% of nonsmokers and 24% of current smokers) reported receiving tobacco direct mail materials in 2006 to 2007 and that receipt of these materials was positively associated with smoking behaviors 6 months later in the overall adolescent and young adult sample. However, our previous analysis had limitations. First, the analysis pooled adolescents (who could not legally purchase tobacco products) with young adults, which might underestimate the effect of receiving these materials on subsequent smoking behaviors. Second, we did not assess the types of direct mail materials received. The effect of tobacco direct mail materials might differ by type of direct mail materials, particularly when some of these materials are coupons that offer discounts for tobacco products and others are simply advertisements. In this study, we analyzed the data from the Minnesota Adolescent Community Cohort (MACC) Study collected when the participants were between the ages of 20 to 28 years. We assessed the prevalence and frequency of, and characteristics associated with receiving tobacco direct mail materials in this young adult sample. We also examined the type of materials received, and characteristics associated with receiving coupons for tobacco products in the mail. Finally, we assessed the effects of receiving cigarette coupons in the mail on subsequent smoking behaviors in this young adult sample. Findings from this study will provide evidence concerning regulation of tobacco direct mail marketing.
