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Adolescent tobacco coupon receipt, vulnerability characteristics and subsequent tobacco use: analysis of PATH Study, Waves 1 and 2
  1. Shyanika W Rose1,
  2. Allison M Glasser1,
  3. Yitong Zhou1,
  4. Tess Boley Cruz2,
  5. Amy M Cohn3,4,
  6. Brianna A Lienemann2,
  7. M Justin Byron5,
  8. Li-Ling Huang5,6,7,
  9. Helen I Meissner6,7,
  10. Lourdes Baezconde-Garbanati2,
  11. Jennifer B Unger2
  1. 1 Truth Initiative Schroeder Institute, Washington, District of Columbia, USA
  2. 2 Keck School of Medicine, University of Southern California, Los Angeles, California, USA
  3. 3 Battelle Memorial Institute, Arlington, Virginia, USA
  4. 4 Department of Oncology, Georgetown University Medical Center, Washington, District of Columbia, USA
  5. 5 Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  6. 6 Master Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan
  7. 7 Tobacco Regulatory Science Program, National Institutes of Health, Bethesda, Maryland, USA
  1. Correspondence to Dr Shyanika W Rose, Truth Initiative Schroeder Institute, Washington DC, District of Columbia 20001, USA ; srose{at}


Objectives We examine adolescent receipt of tobacco coupons and subsequent tobacco use.

Methods Data were from the Population Assessment of Tobacco and Health (PATH) Study (2013–2015). We identified correlates of coupon receipt at Wave 1 (youth sample age 12–17 ; n = 13 651) including demographics, additional vulnerability factors that may place youth at risk of tobacco use and correlates of coupon receipt by channel. We examined associations of Wave 1 coupon receipt with Wave 2 tobacco use using weighted multivariable models.

Results Overall, 7.6% of US youth received tobacco coupons in the 6 months before Wave 1. Coupon recipients were more likely to be women, living outside urban areas, living with a tobacco user, current and former (vs never) tobacco users, having high internalising mental health symptoms and having a favourite tobacco advertisement. Coupons were received primarily through direct mail (56%), product packs (28%) and online (25%). Never tobacco users at Wave 1 who received coupons were more likely to be ever users at Wave 2 (adjusted OR (aOR)=1.42; 95% CI 1.06 to 1.91). Coupon recipients were more likely to use a new tobacco product between waves (aOR=1.67; 95% CI 1.18 to 2.36) and report past 30-day tobacco use at Wave 2 (aOR=1.81; 95% CI 1.31 to 2.49).

Conclusions One in 13 US youth (7.6%) received coupons. Vulnerable youth had the greatest odds of coupon receipt. Coupon recipients had greater odds of tobacco use among never users, trying a new tobacco product and current use. Coupon bans, limits on youth coupon exposure, stronger age verification, pack inserts or restricting coupon redemption may help reduce tobacco use among adolescents, particularly for those at greatest risk.

  • coupon
  • tobacco
  • price promotion
  • youth

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  • Twitter @ShyanikaRose

  • Contributors SWR conceptualised the study and wrote the manuscript. YZ conducted the analyses. All authors contributed to the study design and analysis plan and edited the manuscript. All authors approve the final manuscript.

  • Funding This project was completed as part of the collaborative research being conducted by the National Institutes of Health (NIH) and Food and Drug Administration (FDA) Tobacco Centers of Regulatory Science (TCORS) Vulnerable Populations Working Group. This study is supported in part by grant number U54CA189222 under a subcontract to Westat from NCI, FDA and the Center for Evaluation and Coordination of Training and Research (CECTR) in tobacco regulatory science for SWR and AMG; P50CA180905 from the National Cancer Institute (NCI) and the Food and Drug Administration (FDA) Center for Tobacco Products (CTP) for TBC, JBU, BAL and LB-G; T32CA009492-29 from NCI for BAL; and P50 CA180907 from the NCI and FDA CTP for MJB and L-LH.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Westat Institutional Review Board and Chesapeake IRB.

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

  • Data sharing statement This paper was a secondary data analysis using the PATH Restricted Use Files (RUF). Access to these data is available to researchers through the National Addiction and HIV Data Archive program (

  • Presented at SRNT 2018