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Abstract
Background Point-of-sale tobacco marketing has been shown to be related to tobacco use behaviours; however, specific influences of cigarette price discounts, price tiers and pack/carton availability on cigarette purchasing intention are less understood by the tobacco control community.
Methods We conducted discrete choice experiments among an online sample of US young adult smokers (aged 18–30 years; n=1823). Participants were presented scenarios depicting their presence at a tobacco retail outlet with varying availability of cigarette price discounts, price tiers and pack/carton. At each scenario, participants were asked whether they would purchase cigarettes. Generalised linear regression models were used to examine the associations between of cigarette price discounts, price tiers and pack/carton with intention to purchase cigarettes overall and stratified by educational attainment.
Results Participants chose to purchase cigarettes in 70.9% of the scenarios. Offering price discounts were associated with higher odds of choosing to purchase cigarettes. Reducing the number of cigarette price tiers available in the store was associated with lower odds of choosing to purchase cigarettes. Stratified analysis showed that offering discounts on high-tier cigarette packs increased odds of choosing to purchase cigarettes among young adult smokers with at least some college education, while offering discounts on medium-tier cigarette packs increased odds of choosing to purchase cigarettes among those with some college education or less (eg, with a 10% discount, adjusted odds ratio [AOR]some college=1.62, 95% confidence interval [CI] 1.21 to 2.16; AOR≤high school=1.44, 95% CI 1.08 to 1.93).
Conclusions Availability of cigarette price discounts, price tiers and pack/carton could potentially influence cigarette purchasing behaviours among young adult smokers. Regulating these marketing strategies may, therefore, reduce education-related smoking disparities.
- advertising and promotion
- price
- socioeconomic status
- tobacco industry
Data availability statement
Data are available upon reasonable request. Data requests can be made to Dr. Kelvin Choi at kelvin.choi@nih.gov. These requested will be reviewed accordingly.
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Background
Tobacco marketing has been deemed to be causally linked to tobacco use behaviours.1 In 2018, cigarette companies spent US$8.4 billion to promote and advertise cigarettes in the USA and US$6.1 billion (73.3% of the advertising and promotion expenditures) were spent on providing price discounts at the points of sale, and additional US$62 million on point-of-sale advertising (0.7% of the advertising and promotion expenditures).2 Robertson and colleagues conducted a systematic review on the association between point-of-sale tobacco promotion and cigarette smoking in 2015.3 Evidence from the 20 peer-reviewed studies included in this review led the authors to conclude the existence of a positive association between exposure to point-of-sale tobacco promotion and cigarette smoking.
However, there are several limitations of the current literature on impact of point-of-sale tobacco promotions and cigarette smoking. First, of the 20 studies included in the systematic review, 17 examined the association among youth (<18 years old). Meanwhile, among US 20–39-year-old adults who ever smoked daily, 80.3% smoked their first cigarettes before 18 years old, 48.6% of them began daily smoking after they were 18 years or older.4 Additionally, young adults are the targets of tobacco marketing by the tobacco and convenience store industry.5 6 A previous US national study showed that young adult smokers were most likely to purchase cigarettes from convenience stores/gas stations, and most likely to notice tobacco advertising and promotions at points of sales;7 therefore, it is important to further understand how point-of-sale tobacco promotions influence young adults. Second, of the few studies focused on adults, only two were conducted in the USA (one among college students from three US colleges in a single urban area8 and another with smokers in Vermont9). Consequently, studies using US national samples are needed to understand how point-of-sale tobacco promotions impact young adults’ purchasing behaviours. Third, previous studies examining point-of-sale promotions measured tobacco promotion displays as a whole and did not specifically examine point-of-sale tobacco price promotions (ie, discounts for tobacco products offered at the point of sale). Given that young adult smokers are more price sensitive than older smokers,10 point-of-sale tobacco price promotions are likely to influence young adult smokers’ tobacco purchasing behaviours. Finally, previous studies have shown that tobacco point-of-sale marketing is more prevalent in socioeconomically disadvantaged neighbourhoods than socioeconomically advantaged neighbourhood,11 resulting in higher exposure to tobacco point-of-sale marketing by lower socioeconomic status (SES) individuals.7 However, no studies to date have examined differences in responses to point-of-sale displays by SES, and, therefore, it is unclear if and how this tobacco marketing strategy contributes to SES-related tobacco use disparities.
Beyond point-of-sale price promotions, offering cigarettes at different price tiers is another tobacco marketing strategy. A previous study found that between 2002 and 2011, as cigarette prices in the USA increased, the proportion of US smokers’ smoking discount cigarette brands increased from 25% to 31%.12 Furthermore, another study examining changes in cigarette expenditure minimising behaviours after a US$1.75 cigarette excise tax increase in Minnesota found that the greatest increase in buying a cheaper brand of cigarettes was among adult smokers with less than high school education (+27.5%) compared with those with college education (+11.3%).13 Additionally, 31.5% of smokers in Minnesota reported purchasing cigarettes by the carton to save money;13 however, it is unclear how eliminating cigarettes at different price tiers, in pack or in carton, will influence tobacco use and its SES-related disparities.
Given the current limitations in the literature, we conducted an online experiment with a US national sample of young adult smokers. We aimed to investigate how offering different amounts of price discounts on cigarettes would influence intent to purchase cigarettes. We also aimed to examine how not offering cigarette of different price tiers at the point of sale would influence intent to purchase cigarettes. Finally, we aimed to assess how intent to purchase cigarettes due to these two factors differs by educational attainment. Behavioural economics have used demand curves to examine the relationship between cigarette prices and demand, demonstrating that as cigarette prices increase, estimated cigarette consumption decreases.14 Consumer research also suggested that offering price promotions is associated with increases in purchasing intention.15 16 Additionally, previous research found that higher educational attainment is associated with lower demand for cigarettes;17 therefore, we hypothesised that offering a higher amount of price discount is associated with higher likelihood of intending to purchase cigarettes. We also hypothesised that not offering a lower price tier of cigarettes is associated with lower likelihood of intent to purchase cigarettes. Finally, we hypothesised that these associations will be more prominent among young adult smokers with lower educational attainment. Given that states and localities have or are considering policies to prohibit tobacco price promotions (eg, New York18 and New Jersey19 have enacted policies to prohibit tobacco price promotions and coupon redemption), our expected findings can shed light on how these policies may impact smoking behaviours and education-related disparities among young adults.
Methods
Study population
A sample of US young adult smokers was recruited and surveyed through Qualtrics (https://www.qualtrics.com/research-services/online-sample/) between February and May 2017. Qualtrics partners with >20 web-based panel providers to recruit participants. Inclusion criteria were (1) residing in the USA, (2) having smoked at least 100 cigarettes in their lifetime, (3) currently smoking cigarettes, (4) having purchased cigarette in the past and (5) between the ages of 18 and 30 years. Email invitations were sent by Qualtrics through its partner panel providers to potential participants. Interested individuals completed a short screening survey to determine eligibility. Stratified sampling was employed to obtain similar number of participants in each of the three education categories: high school or below, technical school or some college and bachelor’s degree or above. Participants provided informed consent through the Qualtrics survey software (Qualtrics, Provo, Utah, USA) and completed an online survey. Those who completed the survey with high quality, as determined by Qualtrics, received a US$4 incentive. Of the 1823 participants, 600 completed high school or fewer years of education, 627 completed technical school or some college and 596 completed a bachelor’s degree or more. This study was approved by the University of Saskatchewan Behavioural Research Ethics Board. Participants are compensated through Qualtrics' standard practices.
Study design
We conducted a discrete choice experiment (DCE).20 DCEs have previously been used to examine how different attributes (eg, price, brand, flavour, warning labels) influence tobacco use behaviours (see Regmi et al 21 for a systematic review). The objective of this DCE was to examine factors that influence purchasing intent among young adult smokers, including tobacco use behaviours (eg, brands, consumption level, number of cigarettes in stock), tobacco policies (eg, anticipating a tax increase), offering of noncigarette tobacco products and tobacco industry point-of-sale pricing strategies (eg, price tiers, price promotions, pack/carton sales). The current analysis focused on industry point-of-sale pricing strategies. The study design was developed in consultation with Dr Joffre Swait of the Institute for Choice at the University of South Australia. The DCE consisted of 12 questions presenting various purchase options and asking for decisions at the point of sale. Specifically, participants were told that they would see different scenarios and be asked to make a purchase decision. They were instructed to read the scenario description and to imagine themselves in a store that sells tobacco products. They were also told to expect seeing different products offered by the store, and sales prices were shown in red. Participants were asked to make a purchase decision by clicking the radio button next to it, with an option to choose not to purchase any tobacco products. Figure 1 shows an example of the type of survey question used to elicit preferences with respect to tobacco purchasing. The top section provides participants with the decision context, including the number of cigarettes currently in their possession, whether any tax is planned on packs or cartons and the tier of their usual cigarette brand (provided by participants in a part of the survey prior to the experiment). The bottom section shows a table that displays the offerings at the store. Variation of the contextual factors (ie, future tax increases and number of cigarettes in possession), availability of tiers and quantity (pack vs carton) and levels of price discounts varied across scenarios, while balanced across participants and presented in random sets to avoid order effects. A no-purchase option was offered in every scenario.
A sample scenario from the discrete choice experiment.
Measures
Sample characteristics
Before viewing the DCE scenarios, participants were asked for demographics: age, gender, race/ethnicity, educational attainment, annual household income and state of residence. Participants also provided information about their smoking behaviours, including regular brands of cigarettes and price paid for the last pack of cigarette, whether they regularly purchase cigarettes by pack or by carton and number of cigarettes consumed per day. Regular brand of cigarettes and price paid for the last pack of cigarettes, in conjunction with state of residence, were used to determine price tiers of usual brand.
Independent variables
Three attributes of cigarettes were included in the study design. These included price tiers (high, medium, low), package size (pack, carton) and amount of price discounts (none, 10% off, 20% off, product not offered). Previous research showed that cigarette brands are clustered into three price tiers: discount, premium and super-premium.22 Additionally, studies have shown that smokers who purchased cigarettes in cartons as a mean to save money on cigarettes actually paid lower prices.12 13 A previous study reported that tobacco companies offered about 10% discount on cigarettes after a tax increase;23 however, deeper discounts (eg, buy one get one free, rebates) are sometimes available at points of sale.24 These attributes were captured by six variables (high-tier pack, medium-tier pack, low-tier pack, high-tier carton, medium-tier carton and low-tier carton), each with four categories (no discount, 10% off, 20% off, product not offered). To ensure the prices shown in each scenario matched those participants would see in their areas, we examined the brand-specific cigarette minimum price policies in various states and estimated the average price ratios between discount (low tier), premium (medium tier) and super-premium (high tier) brands. We then applied this ratio to the average cigarette price in each state25 to calculate state-specific prices for low, medium and high-tier cigarettes. Finally, participants were presented prices that matched their self-report state of residence.
Dependent variable
At each scenario, participants were asked to choose the product they would like to purchase. Participants could also choose to not purchase any product. We created a binary dependent variable based on whether they chose to purchase cigarettes (yes/no). If participants chose to purchase cigarettes of any tier, they were classified as having intent to purchase cigarettes. Otherwise, if they chose not to purchase any products, or to purchase tobacco products other than cigarettes, they were classified as having no intent to purchase cigarettes.
Statistical analysis
Descriptive statistics were used to summarise the characteristics of the participants. We employed generalised linear regression models to assess the association of price tiers, package size and amount of price discounts represented by the six independent variables with the binary intent to purchase cigarettes variable (yes/no). These models accounted for clustering of scenarios by participant given each participant viewed multiple scenarios. We further stratified the analysis by educational attainment (high school or less, some college and college graduate) to examine variations of the associations of interest by educational attainment. In a sensitivity analysis, we additionally included demographic variables in the models. Since they did not significantly attenuate the associations of interest, we decided to exclude them in the final models for parsimony. All analyses were conducted in SAS Enterprise V.9.3 (SAS Institute: Cary, North Carolina, USA).
Results
Table 1 summarises the characteristics of study participants. Overall, the average age of the participants was 25.4 years, 45% of them were women, 72.1% were non-Hispanic white and 19.9% reported annual household income less than US$25 000. Regarding smoking behaviours, 89.2% of the participants smoke cigarette brands in the medium tier, 86.2% regularly purchased cigarettes by pack and on average smoked 10.8 cigarettes per day. Some of these characteristics varied by educational attainment. Compared with those with college education, a higher proportion of participants with less than college education was women, had lower annual household income and smoked cigarette brands in the medium price tier.
Overall sample characteristics and by education attainment.
Of the 14 584 scenarios viewed, participants chose to purchase cigarettes in 70.9% of them. The probability of choosing to purchase cigarettes did not vary significantly by educational attainment (high school or less: 70.9%, some college: 71.4%, college degree: 70.5%). Overall, when discounts were offered for a pack of cigarettes, participants had higher odds of choosing to purchase cigarettes (table 2; overall column), except for 10% off a pack of high-tier cigarette (AOR=0.98, 95% CI 0.84 to 1.13) and 20% off a pack of low-tier cigarettes (adjusted odds ratio [AOR]=1.07, 95% confidence interval [CI] 0.91 to 1.27). When discounts were offered for a carton of cigarettes, 20% off a carton of medium (AOR=1.21, 95% CI 1.01 to 1.45) and low-tier cigarettes (AOR=1.65, 95% CI 1.36 to 2.00) was associated with higher odds of choosing to purchase cigarettes; however, 20% off a carton of high-tier cigarettes was associated with lower odds of choosing to purchase cigarettes (AOR=0.77, 95% CI 0.67 to 0.88). Comparing to offering cigarette without discounts, not offering a specific tier of cigarettes (eg, high-tier cigarette packs were not available in the store, figure 1), regardless of package size, was associated with lower odds of choosing to purchase cigarettes (eg, AORhigh-tier pack=0.66, 95% CI 0.58 to 0.74), except for lower tier cigarette by the carton. Compared with offering lower tier cigarettes by the carton with no discount, not offering lower tier cigarettes by the carton was not associated with choosing to purchase cigarettes (AOR=1.03, 95% CI 0.93 to 1.15).
Associations between price discounting and intention to purchase cigarettes overall and by education attainment
These associations varied somewhat by educational attainment. For example, 20% off a pack of high-tier cigarettes was only associated with choosing to purchase cigarettes among those with some college education or above (eg, AORcollege=1.52, 95% CI 1.08 to 2.14). In contrast, discounts on a pack of medium-tier cigarettes were only associated with choosing to purchase cigarettes among those with high school or less and some college education (eg, for a 10% discount, AOR≤high school=1.44, 95% CI 1.08 to 1.93). Discounts on a pack of low-tier cigarettes were not associated with intent to purchase cigarettes among those with some college education. Regarding discounts on cartons, only 20% off a carton of low-tier cigarettes was associated with intent to purchase cigarettes among those with less than college education (eg, AORsome college=1.66, 95% CI 1.20 to 2.29). In contrast, 20% off a carton of high-tier cigarettes was associated with lower odds of choosing to purchase cigarettes but only among those with less than college education (eg, AORsome college=0.74, 95% CI 0.60 to 0.94). Compared with offering cartons of high and medium-tier cigarettes with no discount, not offering cartons of high and medium-tier cigarettes was associated with lower odds of choosing to purchase cigarettes only among those with less than college education (eg, AOR≤high school=0.80, 95% CI 0.66 to 0.97).
Discussion
Previous studies have documented a positive association between exposure to point-of-sale tobacco marketing and tobacco use behaviours;3 however, no studies to date have examined experimentally how specifically point-of-sale cigarette price discounting, package size and price tiers of cigarettes would potentially influence purchasing behaviours among young adult smokers. Based on previous behavioural economics and consumer research studies showing that price reductions and price promotions increase demand and purchasing intent,14–16 we hypothesised that offering price discounts in our experiments would elicit purchasing intent. Through conducting a DCE with a large sample of US young adult smokers, we found that offering cigarette price discounts was associated with intent to purchase cigarettes in most scenarios, supporting our hypothesis. This finding is also consistent with those from a previous study showing that exposure to direct-to-consumer discount coupons is associated with progression of smoking behaviours,26 as well as another previous study reported that 25% of smokers in Victoria, Australia purchased cigarettes on impulse after seeing point-of-sale cigarette displays.27 One exception was when a 20% discount was provided for high-tier cigarettes by the carton, which showed a negative association with intent to purchase cigarettes. Previous marketing research suggested that price promotions could lead to lower perceived product quality and brand choice.28 A 20% discount on high-tier cigarettes by the carton represents the largest discount in these scenarios (>US$15 based on the price shown in figure 1), which may lead participants to discount the quality of these high-tier cigarettes and lead to lower purchasing intent.
We found that responses to cigarette price discounts varied somewhat by educational attainment among this sample of young-adult smokers. For example, discounts for high-tier cigarette packs were only associated with cigarette purchasing intent among those with some college education or above, while discounts for medium-tier cigarette packs were only associated with cigarette purchasing intent among those with some college education or below. Similarly, discounts on low-tier cigarette cartons were only associated with cigarette purchasing intent among those with some college education or below. It is noteworthy that the vast majority of the participants regularly smoke medium-price-tier cigarette brands (which include premium brands like Marlboro and Camel), and manufacturers of these brands often engage retailers in incentive programmes that were found to be associated with cigarette price discounts.29 Additionally, previous research has shown that tobacco retail outlets, as well as point-of-sale tobacco marketing, are more concentrated in lower income neighbourhoods,30 resulting in potentially higher exposure to point-of-sale cigarette price discounting in lower SES smokers than higher SES smoker. Therefore, point-of-sale cigarette price discounts are likely to perpetuate the known SES-related disparities in the USA. Taken together, these findings suggest that prohibiting point-of-sale cigarette price discounts could discourage young adult smokers from purchasing cigarettes, especially among those of lower SES.
An interesting observation is that not offering a particular price tier of cigarettes was associated with lower odds of intent to purchase cigarettes in general, except that not offering lower price tier cigarettes by the carton was not associated with intent to purchase cigarettes. Additionally, the associations of not offering high and medium price tier cigarettes by the carton were only significant among participants with less than college education. These findings suggest that narrowing the range of cigarette price may be an effective strategy to discourage young adult smokers from purchasing cigarettes. Our findings are in agreement with those from a previous study, which projected that raising the minimum cigarette prices could reduce cigarette smoking and its disparities by SES.31 Previous marketing research also suggested that having more choices are associated with purchasing likelihood.32 Therefore, not offering cigarettes of any price tier reduces the number of choices available to the participants, which could in turn reduce their purchase intent.
Our study has the following limitations. First, participants were a non-random sample of young adult smokers recruited through Qualtrics, and, therefore, they may not be representative of all US young adult smokers. Second, since we only recruited smokers, we were unable to examine how point-of-sale cigarette discounts relate to cigarette purchasing intent among nonsmokers, which could be an important research question. Third, our outcome was intent to purchase cigarettes instead of actual cigarette purchase or consumption. While multiple behavioural theories posit that intention to perform a behaviour is a precursor of such behaviour,33 34 it is unclear whether participants would behave the same way if they are actually spending their money. Fourth, it is unclear how our findings translate to long-term purchasing behaviours, since we only assess how participants response to each scenario independently.
In conclusion, in a DCE with US young adult smokers, we found that point-of-sale cigarette price discounts were associated with intent to purchase cigarettes especially among those with less than college education. Our findings provide experimental evidence that point-of-sale cigarette price discounts could influence cigarette purchasing behaviours and potentially subsequent smoking behaviours, particularly among lower SES young adult smokers. These findings suggested that policies implemented by some US states and localities18 19 to prohibit point-of-sale tobacco price promotions could reduce SES-related tobacco use disparities. Additionally, narrowing cigarette price range, potentially by raising the minimum cigarette prices, may compound the benefit of point-of-sale tobacco price promotion prohibition and further reduce tobacco use and its disparities.
What this paper adds
A discrete choice experiment showed that offering price discounts and different price tiers at tobacco point of sale could independently influence young adult smokers’ intention to purchase cigarettes. The influence also varied by educational attainment of these smokers.
These findings suggest that policies to prohibit point-of-sale tobacco price promotions and reducing the variability of cigarette prices at tobacco outlets eg, by raising the minimum prices could reduce young adult smoking disparities by educational attainment.
Data availability statement
Data are available upon reasonable request. Data requests can be made to Dr. Kelvin Choi at kelvin.choi@nih.gov. These requested will be reviewed accordingly.
Ethics statements
Patient consent for publication
References
Footnotes
Contributors KC, KK, and NO designed the study and collected the data; TSM analysed the data; all authors interpreted the results; KC drafted the manuscript; all authors critically reviewed the manuscripts and approved the final version to be published.
Funding This study was supported by the National Institute on Minority Health and Health Disparities Division of Intramural Research. Support from Dr. Joffre Swait at the University of South Australia Institute for Choice was through a contract HHSN 275201400386P.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.