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Tobacco industry marketing to low socioeconomic status women in the USA
  1. Cati G Brown-Johnson1,
  2. Lucinda J England2,
  3. Stanton A Glantz1,3,
  4. Pamela M Ling1,4
  1. 1Center for Tobacco Control Research and Education, San Francisco, California, USA
  2. 2Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  3. 3Division of Cardiology, Department of Medicine, Philip R Lee Institute for Health Policy Studies, San Francisco, California, USA
  4. 4Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Pamela M Ling, Center for Tobacco Control Research and Education University of California, San Francisco, 350 Parnassus Ave. suite 366, San Francisco, CA 94143-1390, USA; pling{at}medicine.ucsf.edu

Abstract

Objectives Describe tobacco companies' marketing strategies targeting low socioeconomic status (SES) females in the USA.

Methods Analysis of previously secret tobacco industry documents.

Results Tobacco companies focused marketing on low SES women starting in the late 1970s, including military wives, low-income inner-city minority women, ‘discount-susceptible’ older female smokers and less-educated young white women. Strategies included distributing discount coupons with food stamps to reach the very poor, discount offers at point-of-sale and via direct mail to keep cigarette prices low, developing new brands for low SES females and promoting luxury images to low SES African-American women. More recently, companies integrated promotional strategies targeting low-income women into marketing plans for established brands.

Conclusions Tobacco companies used numerous marketing strategies to reach low SES females in the USA for at least four decades. Strategies to counteract marketing to low SES women could include (1) counteracting price discounts and direct mail coupons that reduce the price of tobacco products, (2) instituting restrictions on point-of-sale advertising and retail display and (3) creating counteradvertising that builds resistance to psychosocial targeting of low SES women. To achieve health equity, tobacco control efforts are needed to counteract the influence of tobacco industry marketing to low-income women.

  • Tobacco industry
  • Tobacco industry documents
  • Advertising and Promotion
  • Socioeconomic status
  • Priority/special populations
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Introduction

Tobacco companies have viewed women as a key US consumer base since the 1920s1 when cigarettes were promoted as an appetite suppressant (“Reach for a Lucky Instead [of a Sweet]”2). For decades, marketing strategies for women have used emancipation symbolism, from the American Tobacco Company's “Women! Light another torch of freedom!”2 in 1929 to Philip Morris' (PM) “You've come a long way, baby”3 in 1968. In addition, tobacco marketing messages were designed to appeal to what tobacco companies perceived to be women's psychosocial needs, such as offering escape fantasies to overworked and stressed women with Brown and Williamson's (B&W) Capri brand cigarette slogan, “She's gone to Capri and she's not coming back.”4 As higher income, more educated people stopped smoking, tobacco companies looked for ways to maintain their consumer base, including targeting low-income women. In the USA, low-income women are more likely to smoke than their more socially advantaged peers5: 28.7% of women below the poverty line between 2005 and 2010 smoked compared with 16.7% of women at or above poverty.6 Low-income female smokers are also less likely to quit despite similar numbers of quit attempts.7 ,8

In addition to low-income status, cigarette smoking in the USA is associated with other aspects of social disadvantage, including low educational achievement9 and lower occupational attainment among African-Americans.10 Smoking has also been associated with lack of social support, unsafe neighbourhoods and unmet needs for food and medical care.11 The disproportionate burden tobacco imposes on socially disadvantaged women may be due to tobacco industry marketing activities focused on them.

Although previous studies have examined tobacco marketing to various female subpopulations,12–16 there has not been a comprehensive evaluation of marketing strategies focused on socially and economically disadvantaged women. In this study, we describe tobacco industry strategies targeting low socioeconomic status (SES) women in the USA. We defined low SES as disadvantaged social standing, whether related to income, power, privilege or access to resources, and regardless of whether that standing was permanent or transient. We found that since the 1970s, tobacco companies have targeted low SES women in specific subgroups using a variety of strategies, including price, design and novel products.

Methods

We analysed tobacco industry documents related to marketing research and marketing strategies relevant to low SES women available in the Legacy Tobacco Documents Library (legacy.library.ucsf.edu) using standard iterative snowball sampling techniques employed in previous document research and described in detail elsewhere.17 ,18 Searches were conducted between 1 July 2011 and 1 November 2012, and follow-up documents were reviewed as needed for clarification until 5 November 2013. Initial search terms included ‘low-income’, ‘downscale’, ‘low SES’, ‘lower class’, ‘asset poor’, ‘working poor’; combined with ‘female’, ‘women’, ‘wives’; and ‘marketing strategies’, ‘focus groups’, ‘segmentation’, ‘market research’ and ‘target market’. Initial searches yielded thousands of documents and were not limited by date. Documents were reviewed for general relevance; documents containing marketing research or strategies relevant to low SES women based on keyword excerpt were examined in full. Those that were topically relevant (∼1000 total) were reviewed in detail. Related documents were located by searching for the same author, examining files located physically near the original document, or searching with common project names, titles or Bates numbers. Advertising images from the Trinkets and Trash archive (trinketsandtrash.org), general Google searches and Google's image searches were used to verify execution of mentioned plans. This analysis is based on a final collection of 1508 documents.

Two authors (CGB-J and LJE) reviewed the documents to determine the main themes and context, timelines, and names and types of different promotional strategies. They wrote summary memoranda, that were used to guide detailed research questions, such as “Was this effort to distribute coupons successful?” or “How did RJ Reynolds (RJR) define ‘success’ for this promotion?” Using document searching to answer these questions, they wrote additional memos incorporating newly retrieved documents and organised the documents in clusters by emergent themes, such as distribution channels, brand imagery or financial services. These memos were reviewed by multiple authors, and interpretation of each theme and the supporting documentation was validated by all authors. Disagreements and uncertainty in interpretation were resolved by collecting additional data. The authors repeated the iterative search process until saturation of both keywords and documents was reached.

Results

A systematic review of identified tobacco industry documents revealed that tobacco companies have targeted low SES women from at least 1972 through 2007, with efforts focused on military wives, inner-city minority women, ‘job-holding’ women and older price-sensitive females. Targeted marketing efforts included exploiting marketing channels to reach specific subpopulations, conducting detailed psychographic research, using luxury images to target low SES African-American women, offering discounts by mail and at point-of sale, developing innovative product attributes, creating new brands and exploring non-tobacco financial service products. Online supplementary table S1 presents a full inventory of tactics, noting their subpopulation focus.

Military wives, the favoured ‘captive audience’

Military wives were first targeted by the tobacco industry in the 1970s (see online supplementary table S1). The tobacco company Liggett and Myers (subsequently Liggett Group, Inc.) described the benefits of targeting military wives in several ways. They were noted to be a “captive audience, due basically to the self-imposed confinement of the military family to on-base activities.”19 Liggett's Jack Africk, future CEO of US Smokeless Tobacco Company, noted that military wives were “predictable in their social and shopping habits”19 and well-organised, something that could facilitate marketing efforts: “Military wives meet weekly on each and every base. These particular women can bring to bear great product awareness and word-of-mouth advertising.”19 B&W characterised military wives in 1983 as part of the “target of lowermiddle (sic.) class smokers”,20 and RJR has targeted military for Doral, a brand they identified for “low income, low educated” consumers.21

Many tobacco companies—Liggett, RJR, B&W, PM and Lorillard—worked to attract and retain military wives in the 1970s and 1980s through advertising in women's military magazines such as Ladycom and Stateside,22 sponsoring events such as B&W's Bingo Bonanza for military wives clubs,23 distributing cigarette coupons and prizes (see online supplementary table S1) and advertising in the free, commissary-distributed magazines, including Maxi Saver.24 ,25

Interest in military wives continued into the 21st century, as evidenced by a 2000 presentation from Family Media Group publishers emphasising the value of military wives to RJR: “The military wife is young, impressionable and just forming lifelong brand loyalties. She is far from home and is now making her own shopping decisions. Manufacturers realize that if they sell her [the military wife] now, they will have a brand loyal customer for at least the next 50 years.”26

Early attempts to reach low-income, inner-city women: RJR tests distributing coupons with food stamps

In 1976, RJR's marketing department described the distribution of discount coupons within the African-American population as ‘unfeasible’ due to ‘extremely low redemption rates’, ‘control problems’ and inaccessibility of the population through traditional media.27 In an early response to this perceived barrier, RJR developed a programme to deliver cigarette discount coupons to inner-city low-income African-Americans and Latinos using a trusted US government resource, the Food Stamp Program (a programme in which stamps that could be used like cash to purchase food were distributed to qualifying low-income individuals). RJR worked with an agency approved by the US Department of Agriculture to distribute food stamps—the International Express Company (IEC).27–29 RJR planned to distribute coupons for 25 cents off a pack of Salem Lights in an envelope included with food stamps, a substantial savings compared with other coupon offers.27 ,30 RJR coupons were for packs rather than cartons since “the lower-income groups tend to buy single packs” and “less affluent consumer finds it difficult to pay [the higher price of a carton] at one time”.31

RJR internally described recipients of these coupons as primarily ‘welfare mothers’ and viewed this female skew as a project weakness.32 The company also worried about being criticised for “inducing poor people to buy cigarettes with the little money they do have”;32 nevertheless, they conducted coupon/food stamp trials in 1977 in New York, Philadelphia and Cleveland. They later discontinued the programme due to an unproductive partnership with IEC. However, a 1977 memo expressed ongoing interest in the target consumer: “we will continue to investigate methods to maintain the current smokers and generate trial and conversion among new smokers in this important segment [Black and Hispanic markets].”33

Psychographic consumer research on low-income female smokers

The tobacco companies conducted detailed consumer research on women, attending to psychological and social factors with increasingly sophisticated studies. Lorillard's early profiles of female types in the 1970s were crude and included ‘Emotional Bra-Burning Extremists’ and ‘Anti-Libbers,’34 but later became increasingly sophisticated. In the 1980s, RJR studied trends in the population of US women and identified working women as one of the most important segments.35 RJR hired market research firm Decisions Center, Inc. to study the ‘female market’.36 Using interviews and focus groups,37 Decisions Center identified and characterised segments of the female market (figure 1),38 including lower income ‘Job-holders’ (as opposed to career women).36 These women were viewed as likely to see their employment as a temporary state of affairs… They typically do not earn very high salaries and probably spend every cent they earn…their modest incomes keep these purchases in the low to moderate price ranges.36 (italics added)

Figure 1

Decision Center's basic segmentation of the adult female market for RJ Reynolds in 1980 outlines subsegments of the female market.38 Career women were described as ‘content or angry or searching/insecure’, the ‘job-holder’ was ‘resentful of having to work’, young mothers could be ‘angry/frustrated/constrained…overwhelmed/unfulfilled’ and older housewives felt ‘trapped’ and potentially ‘frustrated/angry’.

RJR capitalised on the frugality of non-career, ‘job-holders’ who had family responsibilities on top of a job (figure 1) by presenting cigarettes as little indulgences to offset personal sacrifices: This segment is very aware of price in all areas of buying … They rarely indulge themselves on a real “splurge” but rather have their few little treats that are moderately priced that keep them going (i.e., Charlie or an Avon fragrance). Aside from “the best value,” what motivates these women is some sense that they are doing the right (best) thing.36

In the 1980s, the discount market emerged, propelled by economic factors.39 Tobacco companies strategised that they could counteract low SES female smokers' guilt by alleviating financial burdens through coupons and point-of-sale (POS) discounts. A 1983 analysis by B&W of older low-income female consumers of Raleigh and Belair cigarettes (two discount brands) found that discounting strategies not only counteracted women's guilt but also brought a sense of control to their lives: [Raleigh and Belair female smokers] have very low SESs…They undoubtedly feel they must make every penny count… smoking represents a financial drain on family resources. Saving coupons for household items helps reduce the guilt associated with smoking… …Belair women (and perhaps Raleigh women as well) feel their lives are controlled by outside forces… The ritual of saving coupons helps bring control to one small aspect of their lives.... 40

Coupons were a considered ‘the principal factor’ for retaining these customers.41

Targeting minority women with luxury—low SES African-American females

Tobacco companies also conducted detailed consumer research on psychological and social factors in low-income minority women. A 1985 RJR report on inner-city African Americans, the ‘Salem Black Smoker Reassessment and Exploratory’, described African-American females as very low-income, focused on present needs, modestly goal-oriented compared with their less goal-oriented male counterparts, and having extended family obligations (children, parents, siblings) that dictated their goals.42 The report also noted that traditional marketing strategies, such as coupons and discount brands, fell short since “blacks do not read magazines or newspapers”.42 However, low SES African-American women were still seen as price sensitive. As a result, in 1985 RJR outlined alternative strategies focused on lowering pack prices at retail through B1G1F (buy-1-get-1-free) offers, ‘stickering’ (in-store discounts affixed to packs), ‘cents-off pack coupons’ and ‘serious consideration of 10-pack configuration’.42 RJR believed that pack price promotions needed to be easy to understand and frequent enough ‘to encourage continuity of purchase’.42 These ‘Discount on Demand’ (DOD) promotions continued into the 2000s43 and are part of larger ‘POS’ marketing strategies targeting low SES women.

By 1986, RJR had also started to emphasise luxury. RJR developed the Ritz brand, which targeted lower SES African-American women and focused on fashion through cross-promotion with Yves Saint Laurent (YSL—a luxury clothing brand). Promotions included a fashion hotline—1-800-YSL-RITZ—and distribution of free YSL branded items (pantyhose, scarf, coaster, playing cards)44 (see online supplementary table S1). Contrary to expectations, low-income women felt the Ritz image was pretentious,45 and Ritz sales were not as successful as hoped among lower SES African-American women. Nevertheless, RJR consultants continued to describe low SES African-American consumer receptivity to prestige and luxury imagery. In 1990, the company described the appeal of luxury brands in the context of a new menthol cigarette exploration project:

Prestige, Status, Pride and Luxury are Extremely important To Blacks Who, As a People, Were historically Denied those Things…. The physical And psychological Deprivation that Occurred during And after Slavery gave Rise to Certain wants And needs Which, Even today, affect Black consumer Behavior. Some of Those wants And needs Include stronger Than average Desires for The following:

Instant gratification

Respectful recognition

Status and prestige

OUR TARGET CONSUMER HAS A LOW SES, YET IS WILLING TO PAY A PREMIUM FOR “IMAGE” AND “STATUS” PRODUCTS.46 (bolding in original)

RJR placed advertising in novel locations (beauty shops, bus stops and clubs) to augment long-standing mobile van-based programmes meant to reach low SES African-Americans.47 Online supplementary table S1 lists additional novel strategies targeting low SES African-American women, including free fingernail decals and earrings that featured Salem logos.

New products and brands target low SES women: Chelsea, Dakota

In addition to efforts to reach low-income African-American women, RJR continued to explore strategies to reach other low-income female populations. In 1989, RJR began test marketing another new brand, Chelsea, whose target included less educated females.48 RJR developed Chelsea49 based on their 1985 “Less Educated Smokers Study”, which identified three consumer core needs: “moderation, prestige and savings”.50 While the Ritz brand focused on prestige through luxury, the Chelsea cigarette product exploited the need for moderation (social acceptability) by including a vanilla aroma to mask the smell of smoke.51 ,52 Promotional strategies included ‘scratch n sniff’ magazine advertising inserts, a toll free number (1-800-FREE-T-SHIRT), coupons to address the need for savings (buy one get three free) and placement of consumer testimonials in cigarette packs.52 ,53 RJR also recommended that for less educated female audiences, marketing language should be “more direct, literal… in communicating the TF [Tomorrow's Female, i.e., Chelsea] benefits”, hence the tagline, “Introducing the first cigarette that smells good”.48 This strategy of literal language has evidently been successful. As recently as 2007, taglines written to minimise consumer ‘confusion’54 were still being used, for example, Kool's “Smoother. Wider. Different”.55

Around the same time, RJR's Project VF (‘Virile Female’) led to the development of their Dakota brand, targeting “young, poorly educated white women” (figure 2).56 ,57 Dakota promotions included a “Night of the Living Hunks” sweepstakes for a date with a male stripper (Ref. 58, p. 512). RJR noted that Dakota females would not choose a brand “that would be unacceptable to the target's boyfriends” and so kept the advertising unisex, and not traditionally feminine.59 However, by 1991 Dakota's users had become disproportionately male.60 Attempts to realign the brand with the intended female users included creating a Dakota catalogue (figure 2; see online supplementary table S1).60

Figure 2

RJ Reynolds’ Dakota brand targeted ‘young, poorly educated white women’.56 ,57 The ‘Prime Prospect’ was ‘unpretentiously stylishish (sic),’ wearing ‘leather, denim, silver jewelry, minimal make-up’ and ‘boots or sports shoes’. She listened to Classic Rock—‘Rolling Stones, Led Zepplin, Genesis’—and her activities included ‘outdoors, informal gatherings, local bars, shopping malls, pool/bowling’.60 Image available courtesy of Trinkets and Trash, http://www.trinketsandtrash.org.

A leak of industry documents detailing Dakota marketing strategies sparked media coverage61 ,62 and an outraged public health response,58 ,63 which may have contributed to the removal of Dakota from the marketplace in the early 1990s.

1990s: Female smokers become lower SES overall

Tobacco companies’ interest in low SES and female populations evolved further in the 1990s, when companies recognised that their consumer base had become increasingly low SES. As early as 1994, PM recognised that for even its flagship brand, Marlboro, female smokers skewed low SES. The ‘Top Marlboro Research Priority’ for 1995 was to expand efforts to learn about younger female Marlboro smokers.64 These efforts informed promotions such as a Marlboro Cookbook, which could be purchased with Marlboro Miles (an affinity programme in which consumers could redeem points or miles from cigarette purchases for merchandise). Similar to RJR's strategies for marketing Chelsea to less educated women, Marlboro cookbook designs used simple language, “big bold print, basic words, steps by # [numbers], steps broken up into pictures, all words should be explained (i.e., sautée [sic])”, and meal plans included downscale beverages such as beer or ‘box wine’.65

Targeting ‘unbanked’ low SES women with financial service products (2000–2007)

In a climate of increasing scrutiny and restrictions on conventional advertising, tobacco companies expanded explorations of ways to connect with their now primarily low SES female consumers. They investigated ways to address financial needs unique to low-income populations while facilitating cigarette purchases. A novel approach centred on a variety of smart card products (eg, debit, credit, affinity cards, etc.). In the late 1990s and early 2000s, PM and RJR piloted a number of card products, including the Marlboro Unlimited Card (1997), which provided discounts on cigarette purchases and other opportunities66; the Marlboro Club Card (2001), which provided access to local clubs and bars67; the Camel VIP Club membership card (1995)68; and the Camel Gas Cash card (2000), preloaded with $15 that could be redeemed for gasoline.69

Internal ad-hoc PM teams (ie, the ‘Blue Team’ and ‘Co-Creation team’) first detailed plans to develop alternative financial service products to meet the needs of low-income consumers in 2000, and later in 2004–2005. In a series of proposals to upper management, they described their targeted population as the ‘unbanked’, who were predominantly female, urban, of below-average education, disproportionately Latino or African American, and likely to have incomes below $25 000/year.70 The proposals included a prepaid debit card (initially referred to as the ‘Pioneer Card’; figure 3), which would provide bill pay, direct deposit, savings with interest, money orders/transfers, access to government benefits checks71 and easy-access cash for the unbanked, very low-income consumers without access to traditional banking service. Suggestions for associated services/promotional activities included sponsorship of small women's groups eligible for micro-lending programmes; financial literacy courses; card-based savings clubs; an interactive community website; and receipt of monetary, informational, and organisational support, all developed and administered by PM.72

Figure 3

Philip Morris’ ‘Mission Exploration Project’ explored diversified business solutions, including prepaid debit-like cards in 2000. A subsequent ‘Co-creation Team’ at PM proposed the Pioneer Card, targeted at the ‘unbanked’ who were mainly female, city residents, of below-average education, disproportionately Hispanic or African-American, and likely to have incomes below $25 000/year’.70 This population was in need of “one-stop, end to end, all-encompassing financial service solutions that allow them dignity, privacy, and helps them escape the poverty trap”.70

We found no evidence that this financial services project was ever implemented. However, in 2004, PM described an initiative to transition their Marlboro Miles programme (in which consumers could redeem points or miles from cigarette purchases for merchandise) into a Marlboro Rewards Card debit card.73 A 2004 email outlined the success of PM's first debit card initiative: Last year, we executed our first initiative that used a debit card like instrument, preloaded with $10 that adult smokers could spend on anything in a retail store that accepted Master Card. …We had over 100000 activations of a 300000 card test and over 30000 reloaded their card via a UPC [Universal Product Code] for dollars exchange (up to $25).74

The debit card was distributed via direct mail in 2004.75 However, searches of the tobacco documents archive for PM ‘prepaid’ and ‘smart card’ terms and searches for debit cards in advertising archives after 2005 yielded no further results. General internet searches in 2013 did not yield additional evidence of an active debit card programme.

PM was not the only tobacco company to consider a financial services card for low SES populations. According to PM competitive intelligence, in 2006 Bailey's cigarette (S&M Brands, an upstart tobacco company) launched co-branded prepaid ‘Freedom of Choice’ Discover debit cards reloadable with proofs-of-purchase and distributed in cigarette packages.76 RJR explored cash and debit card products for Winston brand's 50th anniversary (2004). A proposed ‘cash card’ would enable customers to put money on a card via the Winston website for discount cigarette purchases at retail; another proposal was a jointly branded Winston Mastercard,77 which RJR seems to not have pursued. It is unclear whether these other industry-based card programmes explicitly targeted women.

Discussion

It has been well documented that tobacco companies have viewed women as a key US consumer base since the 1920s. In our research, we found that initial industry efforts to target low SES women began at least as early as the 1970s and these efforts continued across the subsequent decades. Over that time, tobacco companies targeted specific subgroups of low SES women, including military wives, inner-city minority women, ‘job-holding’ women and older discount-sensitive women. Targeted marketing efforts included exploiting marketing channels to reach specific subpopulations, conducting detailed psychographic research, using luxury images to target low SES African-American women, offering discounts by mail and at POS, developing innovative product attributes, creating new brands, using literal language in advertising and marketing materials, and exploring non-tobacco financial service products. The creation of new brands exclusively targeting low SES women proved unsuccessful.

Lowering the price of cigarettes has been a consistent industry strategy for targeting low SES women, and tobacco companies have successfully circumvented cigarette taxes by offering discounts through mailed coupons and POS offers.78 POS discounting was one of the pillars of brand promotion for segments that included low SES females, such as RJR's ‘virile female’ segment and inner city African-Americans. To counter POS discounting, POS advertising restrictions (as supported by the Framework Convention on Tobacco Control (FCTC) Article 13) have been instituted in a number of countries, including Australia and New Zealand.79 In addition to fewer tobacco discounts, dedicating tobacco tax revenues to tobacco control programmes could benefit those disproportionately affected.78 ,80 ,81

Tobacco companies have capitalised on the psychosocial needs of US low SES women; tobacco control programmes could counter these efforts through the development of antitobacco messages designed specifically to reach low-income women. A 2009 survey of counteradvertising campaigns identified three themes that drive initiation and continuation of smoking for women but have not been exploited in tobacco control media: stress relief, mood regulation and desire for weight loss.82 The 487 antitobacco ads included in the survey had previously relied on addressing youth smoking or denormalising the tobacco industry, but none addressed these psychologically focused motivators.83 Research is needed to develop antitobacco messages that resonate with low-income populations and that build resistance to targeted advertising. As called for in the FCTC, development of messages may be a good opportunity for low SES women to be included as important stakeholders in the development of policies and campaigns that may impact them.81 ,84

From a gender analysis perspective, reductionist and sexist ideologies are particularly evident in the industry-conducted assessments of needs for low SES women, who have been characterised as ‘welfare mothers’, lacking in self and social confidence,85 ‘submissive and retiring’,86 or ‘controlled by outside forces’.87 In a prior study, young adult African-American participants were shown tobacco industry documents illustrating predatory marketing tactics and disrespect for African-American consumers, which prompted reflective dialogue about tobacco use and the role of industry in participant communities.88 The documents in this study may also be similarly useful in educating low SES women and could help build their resistance to the marketing tactics.

PM attempts to develop financial service programmes for the unbanked could have expanded the company's access to the poor through direct marketing lists.89 Internationally, tobacco companies have used non-tobacco products to gain access to new markets and protect legacy markets (eg, BAT's 1996 introduction of Threadneedle assets to India to ensure the financial continuation of the Indian Tobacco Company).90 Monitoring the marketing practices of parent companies such as Altria and BAT for evidence of new non-tobacco product development (such as financial service products) could provide insight into evolving industry tactics to gain customers and promote tobacco sales. Our findings may have important implications for the growing tobacco epidemic among women in low-income and middle-income countries (LMICs). International treaties and conventions such as the FCTC may be used to disrupt many of the marketing tactics described, as has been suggested in previous reviews of gender and tobacco.81 Actions could include banning tobacco advertising in all media including the internet (FCTC 13.4.e) or the restriction or elimination of price incentives (FCTC 13.4.c).

Limitations

Our study has several limitations. The large number of documents within the Legacy Tobacco Documents Library makes an exhaustive document-by-document review impossible; important documents may have been overlooked. To account for that possibility, we continued searching with different related terms until we began to see the same documents repeatedly, an indication that we had reached topic saturation within the document set. Data triangulation was limited to advertising images in online archives and searches. Resource limitations kept us from reviewing older microfiche and other offline sources. Finally, uncovering more recent industry strategies targeting low SES women within the documentary archive was difficult, as companies have made information less accessible over time.91 However, there is evidence that many tactics targeting low SES women continued after 2007, and in 2011, almost $7 billion—84% of total marketing expenditures in the USA—was spent on price discounting.92

Conclusion

There are major disparities in smoking prevalence between low SES and higher SES populations. Tobacco companies have used specific targeted marketing practices to reach some of the most vulnerable members of society, exacerbating these disparities. Monitoring tobacco industry marketing strategies targeting vulnerable groups and their effects on smoking behaviour should be a critical part of tobacco control efforts to reduce SES disparities. Tobacco control programmes should also attend to the possibility that the industry may use similar marketing tactics in LMICs.

Policies that restrict tobacco marketing channels, for example, POS advertising and direct mail, could undermine tobacco industry marketing to low SES women and reduce disparities. Given that price reductions have been used to encourage low SES women to smoke, elimination of discounts and couponing would be expected to reduce smoking among low SES women. To achieve health equity, tobacco control efforts are needed to counteract the influence of tobacco industry marketing to low-income women.

What this paper adds

  • Women are known to be an important target of tobacco industry marketing, and tobacco is used disproportionately by the poor. This is the first study using previously secret tobacco industry documents to describe marketing tactics specifically targeting low-income and low socioeconomic status (SES) women. Our study shows that tobacco companies focused numerous marketing efforts on low SES women, including military wives, low-income inner-city minority women, ‘discount-susceptible’ older female smokers and less-educated young white women. Strategies included using food stamp (US-sponsored food assistance) distribution channels to reach the very poor, discounting and distributing coupons at point-of-sale and via direct mail, and appealing to specific psychosocial needs. Understanding these marketing strategies may improve policy and countermarketing efforts to address or prevent tobacco use among low SES women in the USA and internationally.

References

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Supplementary materials

  • Supplementary Data

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Footnotes

  • Contributors CGB-J collected data and led the analysis, interpretation and writing. LJE collected data and contributed to the analysis, interpretation and writing. SAG supervised data collection and contributed to the analysis, interpretation, writing and funding. PML conceived the study, oversaw data collection and contributed to the analysis, interpretation, writing and funding. All authors contributed to the revision and review of the manuscript and approved the final version for submission.

  • Disclaimer The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the National Institutes of Health.

  • Funding This research was supported in part by National Cancer Institute Grant CA-113710 and CA-87472.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This article is an analysis of previously secret tobacco industry documents, all of which are freely available on the internet at legacy.library.ucsf.edu.

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