Background Cigarette smoking continues to be a leading cause of preventable deaths in the USA, in part because the USA has not adopted the WHO Framework Convention on Tobacco Control. One way the tobacco industry counteracts tobacco control policies is by heavily advertising cigarettes at the point of sale in retailers (eg, at the cash register) and by offering discounts on cigarettes.
Design A within-subject experimental design with adults who smoke cigarettes daily (n=281) investigated whether: (1) exposure to images of cigarette promotions in an online experiment is associated with greater cigarette craving relative to viewing images of non-smoking cues, and (2) if exposure to images of point-of-sale cigarette promotions with a discount (vs without) increases cigarette craving. The study also examined how participants’ subjective social status (compared with others in the USA) relates to cigarette craving after exposure to images of cigarette promotions with and without a discount.
Results In an online experiment, exposure to images of smoking cues, including point-of-sale cigarette promotions, elicited greater craving relative to non-smoking cues (all p<0.001). In addition, images of promotions with a discount elicited higher levels of craving compared with those without a discount (b=0.09, p=0.001). Although participants with a higher (vs lower) subjective social status craved cigarettes less overall (b=−0.12, p=0.012), there was no difference in their craving between images of promotions with and without a discount, while craving was higher for images of promotions with a discount than without for participants with higher subjective social status (b=0.06, p=0.021).
Conclusion Viewing images of point-of-sale cigarette promotions can causally increase cravings to smoke, which may also apply to real-world retail settings that display cigarette promotions. Restricting point-of-sale promotions generally, and discounts specifically, could help reduce cigarette smoking and address tobacco use disparities in the USA.
- advertising and promotion
- socioeconomic status
- tobacco industry
Data availability statement
Data are available upon reasonable request. All datasets and analysis code are available upon reasonable request.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Contributors All authors reviewed the manuscript. MA wrote the full draft with support from all of the authors and is the guarantor of this manuscript. MA, NC, BDM and EBF contributed to the study design. JC-T and AMP contributed to creating stimuli and data collection. LH and AAS served as scientific advisors to the study design and manuscript creation.
Funding We acknowledge support from the National Cancer Institute (1R01CA229305-01A1; EBF, PI), the Food and Drug Administration (U54 CA229973; AAS, PI) and University of Pennsylvania’s Presidential PhD Fellowship (MA).
Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of any of the funding agencies.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Author note Mindful that our identities can influence our approach to science (Roberts et al, 2020), the authors wish to provide the reader with potentially relevant information about our backgrounds. With respect to race/ethnicity, one of us self-identifies as black mixed race, one as Latinx and six as white. With respect to gender identity, five of us identify as women and three of us identify as men.
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.