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.

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.

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.

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.

The tobacco industry’s growing reliance on direct mail marketing suggests that it has proved to be effective. Receipt of direct mail and participation in its promotions certainly has the potential to influence smoking initiation. However, in its current form, its potential to increase consumption and impede cessation is unquestionable. Coupons are designed to reduce price and offset the impact of increased taxes and other tobacco control efforts, whereas brand-loyalty programs reward smokers and encourage additional purchases.12–14 Although purportedly developed to prevent brand switching, these marketing strategies at their most basic level help keep smokers smoking.

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.

TABLE 1— Prevalence and Adjusted Odds Ratio for Participation in Industry Marketing or Promotion in Past 6 Months, by Smoking Status, Gender, Race, and Age: New Jersey Adult Tobacco Survey, 2001
TABLE 1— Prevalence and Adjusted Odds Ratio for Participation in Industry Marketing or Promotion in Past 6 Months, by Smoking Status, Gender, Race, and Age: New Jersey Adult Tobacco Survey, 2001
 Received Direct Mail (n = 3843)Used Couponsa (n = 1401)Brand Reward Systema (n = 1401)
 PercentageOR (95% CI)PercentageOR (95% CI)PercentageOR (95% CI)
Smoking statusb
    Never/former10.7ReferentNot available
    Recent quitter22.22.37 (1.37, 4.10)*13.2Referent7.1Referent
    Current smoker35.24.47 (3.63, 5.50)*21.31.80 (0.89, 3.46)18.92.78 (1.16, 1.66)*
    Female16.61.20 (0.98, 1.48)26.31.83 (1.32, 2.54)*17.20.92 (0.65, 1.30)
    Black9.80.45 (0.31, 0.65)*11.80.44 (0.24, 0.81)*4.90.20 (0.07, 0.54)*
    Hispanic7.90.39 (0.25,0.60)*6.90.25 (0.11, 0.58)*13.50.57 (0.28, 1.15)
Age group
    25–4418.11.29 (0.97, 1.71)20.31.71 (1.09, 2.68)*21.61.74 (1.12, 2.71)*
    45–6416.61.14 (0.84, 1.53)23.92.02 (1.26, 3.22)*14.21.06 (0.64, 1.73)
    ≥ 6512.70.93 (0.64, 1.35)20.91.68 (0.92, 3.10)18.01.34 (0.72, 2.50)
Total16.4 20.5 17.8 

Note. OR = odds ratio; CI = confidence interval.

a Questions only asked of current smokers and recent quitters.

b Never/former smokers are defined as those who have not smoked 100 cigarettes or have smoked 100 cigarettes, do not smoke now, and quit 1 year ago or more. Recent quitters are defined as those who have smoked 100 cigarettes, do not smoke now, and have quit within the 12 months preceding the survey. Current smokers are defined as those who have smoked 100 cigarettes and now smoke some days or every day.

* P < .05.

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.


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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. “Tobacco Industry Direct Mail Marketing and Participation by New Jersey Adults”, American Journal of Public Health 94, no. 2 (February 1, 2004): pp. 257-259.


PMID: 14759937