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The longitudinal association between coupon receipt and established cigarette smoking initiation among young adults in USA
  1. Leeann Nicole Siegel1,
  2. Steven Cook2,
  3. Hayoung Oh3,
  4. Alex C Liber3,
  5. David T Levy3,
  6. Nancy L Fleischer2
  1. 1Tobacco Control Research Branch, National Cancer Institute, Bethesda, Maryland, USA
  2. 2Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
  3. 3Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
  1. Correspondence to Dr Leeann Nicole Siegel, Tobacco Control Research Branch, National Cancer Institute, Bethesda, MA 20892, USA; leeann.siegel{at}


Introduction Tobacco companies frequently distribute coupons for their products. This marketing tactic may be particularly effective among young adults, who tend to be especially price-sensitive. Young adulthood is also a stage during which many individuals initiate established cigarette smoking and are especially vulnerable to the effects of tobacco marketing.

Methods We used five waves of data from the US Population Assessment on Tobacco and Health Study (2013–2019) to assess the longitudinal relationship between cigarette coupon receipt and initiation of established cigarette smoking among young adults (18–24 years) who did not report current smoking and had smoked <100 cigarettes in their lifetime at baseline. Initiation of established cigarette smoking was defined as reporting current cigarette use and having smoked ≥100 cigarettes at follow-up. To test this relationship, we fit four discrete time survival models to an unbalanced person-period data set. The first model included our time-varying coupon receipt variable, which was lagged one wave. Subsequent models added sociodemographic, cigarette smoking exposure and other tobacco use variables.

Results Adopting the model adjusting for sociodemographic variables, respondents who received a coupon were found to be more likely to initiate established cigarette smoking at follow-up (adjusted HR (aHR): 2.31, 95% CI 1.41 to 3.80). This relationship remained significant when controlling for all covariates in the fully adjusted model (aHR: 1.96, 95% CI 1.18 to 3.26).

Conclusions These findings show that receiving tobacco coupons may increase the likelihood that young adults will initiate established cigarette smoking, underscoring the need to address the effects of this tobacco marketing tactic.

  • advertising and promotion
  • tobacco industry
  • priority/special populations

Data availability statement

No data are available.

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  • Contributors All authors contributed to the planning and design of this study. LNS and SC led the statistical analyses and wrote the draft manuscript. NLF, ACL, DTL and HO edited the manuscript. All authors reviewed the manuscript and confirmed the approval of the submitted manuscript. LNS is the guarantor of the study.

  • Funding Research reported in this presentation was supported by the National Cancer Institute of the National Institutes of Health under Award Number U54-CA229974.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.