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Receipt of tobacco direct mail/email discount coupons and trajectories of cigarette smoking behaviours in a nationally representative longitudinal cohort of US adults
  1. Kelvin Choi1,
  2. Julia Cen Chen1,
  3. Andy S L Tan2,3,
  4. Samir Soneji4,
  5. Meghan B Moran5
  1. 1 Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
  2. 2 Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
  3. 3 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  4. 4 Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
  5. 5 Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Kelvin Choi, Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA; kelvin.choi{at}


Background We assessed whether receipt of coupons—via direct mail or e-mail—was prospectively related to trajectories of smoking behaviours.

Methods Data were from a cohort of US adults (n=26 447) who participated in wave 1 (2013–2014) and wave 2 (2014–2015) of the Population Assessment of Tobacco and Health Study. Participants reported receipt of tobacco direct mail/email coupons in the past 6 months in wave 1 and their smoking status in both waves. Weighted multiple logistic regressions were used to examine demographic correlates of receiving tobacco direct mail/email coupons at wave 1 and to examine the prospective effect of receiving tobacco coupons on trajectories of smoking behaviours.

Findings At wave 1, 10.7% of never smokers, 13.9% of experimental smokers, 37.1% of current smokers and 16.5% of former smokers reported receiving tobacco direct mail/email coupons. Lower education and higher poverty adults and non-Hispanic white current smokers were more likely to have received these coupons (p<0.05). Receiving tobacco direct mail/email coupons at wave 1 was associated with increased odds of smoking initiation among never smokers (adjusted odds ratio (AOR)=2.28, 95% CI 1.36 to 3.83), becoming established smokers among experimenters (AOR=1.62, 95% CI 1.29 to 2.04), becoming daily smokers among non-daily smokers (AOR=1.56, 95% CI 1.23 to 1.99) and smoking relapse among former smokers between waves (AOR=1.91, 95% CI 1.39 to 2.65). Receiving these coupons at wave 1 was associated with reduced odds of smoking cessation ≥6 months among current smokers (AOR=0.71, 95% CI 0.58 to 0.88).

Conclusions Tobacco direct mail/email coupons encourage and sustain smoking and disproportionately affect lower socioeconomic populations.

  • disparities
  • advertising and promotion
  • public policy
  • prevention
  • cessation

Statistics from


  • Contributors KC was responsible for study concept and drafted the manuscript. JCC conducted statistical analysis. All authors provided critical revision of the manuscript for important intellectual content. All authors approved the final version for publication.

  • Funding National Institute on Minority Health and Health Disparities Division of Intramural Research, and National Institute on Drug Abuse and Food and Drug Administration Center for Tobacco Products (K01DA037903).

  • Disclaimer Opinions and comments expressed in this article are authors’ own and do not necessarily represent those of the US Government, Department of Health and Human Services, National Institutes of Health and National Institute on Minority Health and Health Disparities.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This research is a secondary data analysis of deidentified data and was determined by the National Institutes of Health Office of Health Subjects Research Protection to be exempted from review by an Institutional Review Board.

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

  • Data sharing statement The data are available to the public.

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