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Research paper
Receipt and redemption of cigarette coupons, perceptions of cigarette companies and smoking cessation
  1. Kelvin Choi1,
  2. Deborah J Hennrikus1,
  3. Jean L Forster1,
  4. Molly Moilanen2
  1. 1Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
  2. 2ClearWay MinnesotaSM, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Kelvin Choi, Division of Epidemiology and Community Health, University of Minnesota, 1300 South Second Street Suite 300, Minneapolis, MN 55454, USA; choix137{at}umn.edu

Abstract

Background Although it is known that cigarette companies use cigarette coupons to market their products, little is known about the characteristics of those who receive these coupons. The influence of receipt and redemption of these coupons is also unknown.

Methods Participants of the Minnesota Adult Tobacco Survey Cohort Study who were smokers in 2008, completed surveys in 2008 and 2009, and had smoked for at least 6 months between those surveys, were included. In 2009, participants reported whether they had received cigarette coupons in the past 12 months, and whether they had used the coupons. They also reported their perceptions of cigarette companies and their smoking status. Multivariate logistic regressions were used to assess associations between receiving and redeeming coupons, perceptions of cigarette companies, and smoking status.

Results Overall, 49.4% of the sample reported receiving cigarette coupons, and 39.9% redeemed them (80.1% of those who received these coupons). Female, younger and heavier smokers were more likely to report receiving these coupons (p<0.05). Smokers who received these coupons were more likely to agree that cigarette companies care about their health and do the best they can to make cigarettes safe, and less likely to agree that cigarette companies lie (p<0.05). Smokers who used these coupons were less likely to quit smoking (p<0.05).

Conclusions Our findings suggest a negative association between cigarette coupons and smoking cessation. Longitudinal studies are needed to establish whether cigarette coupons influence smoking behaviour to inform the necessity for policies to prohibit the use of these coupons to assist smokers to quit smoking.

  • Advertising and Promotion
  • Cessation
  • Price
  • Tobacco industry

https://doi.org/10.1136/tobaccocontrol-2012-050539

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    Introduction

    Cigarette companies have a long history of investing in various marketing strategies to promote their products; providing coupons to customers is one of these strategies.1 Cigarette companies have used coupons to counter the effect of cigarette taxes on cigarette consumption,2 and spent US$360 million in 2008 in the USA alone, in providing such coupons.3 These coupons can be obtained through various means (eg, magazines/alternative newspapers,4 bar/club promotion activities,5 and through the mail4). Cigarette coupons can be conceptualised as a loyalty programme, where, through continuous interactions between the cigarette companies (providing coupons) and their customers (redeeming coupons), cigarette companies collect data on consumer behaviours for targeted direct mail advertisements, and increase their consumers’ sense of recognition by the companies as important customers.6 ,7 These interactions, in turn, are postulated to enhance consumers’ perceptions of, and loyalty to, the cigarette companies.7 Increased loyalty to cigarette companies may then decrease smokers’ determination to quit smoking; smokers who are loyal to their brand may also defend the brand, and therefore, be less receptive to antismoking messages.8

    Very little is known about the receipt and redemption of cigarette coupons. Hyland and colleagues, using data from the Community Intervention Trial for Smoking Cessation collected in 2001, found that 18% of smokers reported using coupons during the 5 years prior to their data collection.9 We have previously examined use of various price-minimising strategies among smokers in the Minnesota Adult Tobacco Survey (MATS) Cohort Study, and found that 48.5% of smokers used coupons and in-store promotions to save money on cigarettes in 2008.10 We also found that younger smokers, heavier smokers and non-Hispanic Caucasian smokers were more likely to use coupons and promotions. However, the measure of coupon redemption was in conjunction with other price-minimising strategies (eg, smoking discount brand, using promotions), and therefore, did not allow us to isolate the effects of using cigarette coupons, or the characteristics of adults who received them.

    We used data from the MATS Cohort Study collected in 2008 and 2009 to assess the prevalence of receipt and redemption of cigarette coupons among smokers. We investigated the characteristics that were associated with receiving cigarette coupons to determine the target market of this particular cigarette-marketing strategy. We also assessed the association of receiving cigarette coupons on smokers’ perceptions of the cigarette companies and smoking cessation.

    Methods

    Study population

    The MATS Cohort Study is designed to further study the quitting process and the influence of various factors (eg, tobacco control policies, and media campaigns) on smoking-related attitudes and behaviours. The details of the study are reported elsewhere.11 In brief, participants of the cohort were drawn from the 12 580 MATS 2007 participants randomly selected from the Minnesota adult population (n=7532) and Blue Cross Blue Shield members (n=5048). Those who had smoked more than 100 cigarettes in their lifetime, and were current smokers, or former smokers who quit smoking less than 10 years prior to 2007 (n=3147), were eligible for enlisting in the cohort. Among these, 2436 (77%) agreed to participate in the cohort study and were interviewed every year between April and June from 2008 to 2010. Trained interviewers used computer-assisted telephone interviewing to conduct the surveys, and participants received a US$20 incentive after completing each survey. For this study, we included participants who reported smoking cigarettes at least 1 day in the past 30 days on the 2008 survey (n=816), and completed the survey in 2009 (n=625, retention rate=76.6%). Among these participants, we excluded those who reported on the 2009 survey that they had quit smoking more than 6 months previously (n=38) to ensure that participants who received cigarette coupons would have adequate opportunity (at least 6 months) to redeem the received coupons (final sample n=587). This exclusion criterion was used to reduce the bias in self-reported redemption of coupons due to the inclusion of participants being ex-smokers during the majority of the period of interest—the period between the 2008 and 2009 surveys. All study protocols and instruments were reviewed and approved by the Westat institutional review board.

    Measures

    In 2009, participants were asked if they had received any coupons for a free or discounted pack of cigarettes in the past 12 months. Participants who reported receiving coupons in the previous 12 months in 2009 were asked if they had redeemed these coupons. We categorised these responses into redeemed coupons, received but not redeemed coupons, and not received coupons.

    Participants’ perceptions of the cigarette companies and smoking behaviours were assessed in 2009. Participants were asked if they agreed with the following statements: (1) cigarette companies care about my health; (2) cigarette companies do the best they can to make cigarettes safe and (3) cigarette companies lie. We asked participants to report the number of days of smoking cigarettes in the past 30 days, and those who had not smoked in the past 30 days were classified as having quit smoking.

    Information on demographic characteristics was collected in 2007. Participants’ age (classified into five age groups: 20–29, 30–39, 40–49, 50–59 and >60 years in 2009), gender were assessed. Other covariates were assessed in 2008. Education (categorised into less than high school, high school graduate, some college, and college graduate or above), and annual household income (categorised into less than US$25 000, 25 000–50 000, 50 000–75 000, and more than 75 000) were assessed. Participants’ smoking intensity was assessed by the product of the number of days smoked in the past 30 days, and the number of cigarettes smoked on a typical day that they smoked, and was categorised into ≤150, 151–300, 301–600 and ≥601 cigarettes per month. Participants were also asked if someone close to them (eg, parents, spouse, close friends and relatives) smoked or used other forms of tobacco, and if they were seriously considering quitting smoking in the next 6 months.

    Statistical analysis

    We first assessed the association between the sociodemographic characteristics, smoking intensity, family/peer smoking, intention to quit smoking in 6 months, and receipt of cigarette coupons, using multivariate logistic regressions. We then assessed the association between receipt of coupons and each perception in separate logistic regression models, while simultaneously adjusting for sociodemographic characteristics, smoking intensity, family/peer smoking and intention to quit smoking in 6 months, to control for the differences between those who did and did not report receiving cigarette coupons. Finally, we estimated the association between redemption of coupons and cessation in a logistic regression model, adjusting for the potential differences in sociodemographic characteristics, smoking intensity, family/peer smoking and intention to quit smoking in 6 months between the two groups of participants. All analyses were conducted in SAS V. 9.2.12 ORs and 95% CIs were estimated.

    Results

    Characteristics of the sample are reported in table 1. Overall, 290 participants (49.4%) reported receiving cigarette coupons in the past 12 months in 2009. Women were more likely than men to report receiving cigarette coupons (p<0.05). Younger participants were more likely than older participants to report receiving cigarette coupons (p for trend <0.001): 64.4% of participants aged 20–29 years reported receiving coupons, while only 28.0% of those aged 60 years or above reported receiving coupons (adjusted OR (AOR)=5.72, 95% CI 3.02 to 10.82). Participants who smoked more cigarettes per month were more likely to report receiving cigarette coupons (p for trend<0.01).

    View this table:
    Table 1

    Characteristics associated with receipt of tobacco coupons: Minnesota Adult Tobacco Survey Cohort Study, 2008–2009*

    Among all participants, 137 (23.5%) agreed that cigarette companies care about their health, 123 (21.4%) agreed that cigarette companies do the best they can to make cigarettes safe, and 462 (81.3%) agreed that cigarette companies lie. Table 2 summarises the associations between receipt of cigarette coupons and perceptions of cigarette companies adjusting for covariates. Participants who reported receiving cigarette coupons in the previous 12 months were more likely than those who did not report receiving coupons to agree that cigarette companies care about their health (AOR=1.79, 95% CI=1.18 to 2.72), and that cigarette companies do the best they can to make cigarettes safe (AOR=1.84, 95% CI=1.18 to 2.87). Additionally, those who reported receiving cigarette coupons were less likely than those who did not report receiving cigarette coupons, to agree that cigarette companies lie (AOR=0.55, 95% CI=0.34 to 0.87).

    View this table:
    Table 2

    Multivariate analysis of variables associated with participants’ perceptions of cigarette companies: Minnesota Adult Tobacco Survey Cohort Study, 2008–2009*

    Of those who reported receiving cigarette coupons in the past 12 months, 234 (80.1%) reported redeeming these coupons (39.9% of the entire sample). We found that participants who reported on the 2009 survey that they had redeemed cigarette coupons were less likely than those who did not receive cigarette coupons to abstain from smoking in the past 30 days (AOR=0.19, 95% CI=0.06 to 0.60), after controlling for sociodemographic characteristics, smoking intensity, family/peer smoking, and intention to quit smoking in 6 months, measured in 2007 and 2008 (table 3). Those who received, but did not redeem coupons were more likely than those who did not receive coupons to abstain from smoking in the past 30 days (AOR=2.90, 95% CI=1.20 to 7.03). The association remained significant (p<0.001) after further adjusting for perceptions of cigarette companies.

    View this table:
    Table 3

    Multivariate analysis of determinants of abstinence from smoking in the previous 30 days: Minnesota Adult Tobacco Survey Cohort Study: 2008–2009*

    Discussion

    Cigarette coupons are an understudied marketing strategy used by cigarette companies. Previous studies have estimated the prevalence of use of cigarette coupons,9 ,10 but did not report the prevalence of receipt of cigarette coupons and characteristics associated with receiving these coupons. We believe this is the first study to estimate the prevalence of receiving cigarette coupons among a population of smokers. We found that 49.4% of smokers in our sample reported receiving cigarette coupons, which suggests that cigarette coupons are a prevalent marketing strategy used by cigarette companies to target smokers.

    We also found that female smokers, younger smokers and heavier smokers, were more likely to report receiving these coupons. Results of previous studies suggest that cigarette companies are targeting female and younger smokers,13 ,14 and indicate that these groups are more likely to redeem coupons relative to men and older smokers, respectively.15 ,16 Provision of cigarette coupons may entice female and younger smokers to continue smoking. This is consistent with an application of behavioural learning theory to marketing by Rothschild and Gaidis,17 which posited that provision of coupons can shape repeated purchase behaviour among consumers.

    Young adult smokers (ages 20–29 years) in our sample were most likely to receive cigarette coupons. This may be because cigarette companies have been promoting cigarettes in bars/clubs where young adults congregate.5 Young adult smokers, therefore, may receive cigarette coupons through these promotional activities, and many allow their IDs to be swiped for addresses, which subsequently leads to cigarette companies sending them cigarette coupons in the mail.

    We also found that heavier smokers, independent of gender and age, were more likely to receive cigarette coupons. Previous studies have found that about 35% of current smokers received mail coupons directly in the mail,18 and heavier smokers are more likely to redeem the coupons.10 It is likely that coupon redemption informs cigarette companies that smokers are responsive to these coupons, and prompts the companies to target them with more direct mail coupons.19 However, since we did not collect information about sources of coupons, we were unable to confirm this process.

    Despite the antismoking campaigns that focus on the tobacco industry's deceptive marketing tactics (eg, the Truth campaign20), about 20% of smokers still hold positive perceptions of cigarette companies, believing that cigarette companies care about their health, try the best to make cigarettes safe, and are honest. We found that these perceptions were positively associated with the receipt of cigarette coupons. Given the cross-sectional nature of the data, we cannot determine whether use of coupons precedes or follows the development of these perceptions. We suspect that the associations are bidirectional. Smokers who have favourable attitudes toward cigarette companies are more likely to sign up for cigarette coupons (either through the official brand websites, or by allowing their IDs to be swiped during cigarette promotional activities at bars/clubs), and therefore, more likely to receive these coupons. On the other hand, smokers who receive and use cigarette coupons may feel that they are valued by the cigarette companies as important consumers, which may, in turn, reinforce their positive attitudes toward tobacco companies. Smokers who receive and use cigarette coupons may develop loyalty to the cigarette companies,7 and may then be less receptive to negative statements about the cigarette companies.8 If this is true, smokers who receive cigarette coupons may be less receptive to antitobacco messages exposing cigarette companies’ deceptive marketing tactics. Future research is needed to test this hypothesis in order to inform the design of antismoking messages that will induce the least reactance among smokers.

    We found that 39.9% of the study sample used the cigarette coupons they received. This estimate is higher than that reported in a previous study (18%) conducted in 2001,9 possibly because of the continuous increase in cigarette prices over time that might have prompted cigarette companies to provide more coupons, and more smokers to use coupons. Furthermore, differences in sample characteristics between the two studies might explain the difference of the estimated prevalence of coupon use. The previous study included an older adult sample (38 years of age or more), while our sample included young adults, the age group most likely to use coupons. In addition, the previous study defined current smoking as ‘smoked everyday’ or ‘some days’, while we counted only those who smoked at least 1 day in the past 30 days as ‘current smokers’.

    To our knowledge, this is the first study to report a negative association between the use of cigarette coupons and smoking cessation behaviour. We found that smokers who redeemed cigarette coupons were less likely than those who did not receive coupons to report abstinence from smoking in the previous 30 days. It is possible that decreasing cigarette prices with coupons decreases an important incentive to quit smoking: price.21 If future longitudinal studies confirm our findings on the association between coupon redemption and smoking cessation, prohibiting redemption of cigarette coupons may be an effective strategy to encourage abstinence. New York State is the only state that does not allow retailers to use cigarette-promotional programmes (eg, coupons, ‘buy-down’ promotions) to sell cigarettes under their minimum legal price through its State's minimum cigarette price law. Consequently, the minimum cigarette prices in New York State were significantly higher than other states with and without a minimum cigarette price policy.22 Meanwhile, 25 other states that have minimum cigarette price regulations, do not prohibit use of promotional programmes.23 Therefore, updating these regulations to prohibit the use of cigarette coupons could assist smokers to quit smoking. The US Food and Drug Administration, which has been granted the authority to regulate marketing of tobacco products, may also consider a federal-level policy to prohibit issuing and/or redemption of cigarette coupons. This policy intervention may also reduce the potential influence of receiving cigarette coupons on smokers’ loyalty to the cigarette companies, and increase their receptivity to antismoking messages. Interestingly, we found that smokers who received, but did not redeem coupons, were more likely than those who did not receive coupons, to abstain from smoking in the past 30 days. This is probably because those who were attempting to quit smoking purposefully, did not redeem the coupons they received, and/or they received coupons after they had already quit smoking.

    Our findings should be interpreted with caution. It is possible that, because past use of cigarette coupons and current smoking status were assessed in the same survey, participants who quit smoking were less likely to report past redemption of cigarette coupons. To minimise this bias, we restricted our analysis to those who smoked at least 6 months of the period of interest between the 2008 and 2009 surveys. Although this did not completely resolve the issue, it ensured that all subjects included in the analyses had adequate opportunity to receive and redeem cigarette coupons. Unobserved confounding may also partially explain the associations we observed. To overcome these methodological limitations, future studies using longitudinal designs to track redemption of cigarette coupons and smoking behaviours are needed. Finally, the generalisability of our findings may be limited because of our state-specific sample, and the fact that the majority of the participants were non-Hispanic Caucasians (89.5%, reflective of the Minnesota population). Therefore, findings may not be generalisable to other states with greater racial/ethnic diversity. However, there is no report that receipt and redemption of cigarette coupons differ by geographical location.

    In conclusion, cigarette coupons are a prevalent marketing strategy used by the cigarette companies to market their products to smokers, evident by our finding that 49.4% of smokers reported receiving these coupons. Female, younger and heavier smokers were more likely to report receiving cigarette coupons. Receiving these coupons was associated with positive perceptions of the cigarette companies, and redemption of these coupons was associated with lower likelihood of abstinence from smoking, at least in the past 30 days. Prohibiting the redemption of cigarette coupons through state and federal-level policies may undermine the influence of these coupons on smokers’ perceptions of, and loyalty to, cigarette companies, and assist smokers to quit smoking.

    What this paper adds

    • While it is known that cigarette companies used cigarette coupons to market their products, the prevalence of receipt and redemption of these coupons, the characteristics of those who received these coupons, and the effect of receiving and redeeming these coupons have not been documented.

    • We found that 49.4% of the smokers received cigarette coupons, and that 39.9% of them redeemed these coupons. Female, younger and heavier smokers were more likely to receive these coupons.

    • Smokers who received these coupons were more likely to think positively about the tobacco companies, and smokers who redeemed these coupons were less likely to quit smoking.

    • Prohibiting the redemption of cigarette coupons may promote smoking cessation.

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    Footnotes

    • Contributors All authors participated in conceptualising and designing the study, collecting the data, conducting the analyses, and writing the article.

    • Funding This work was supported by Clearway Minnesota.

    • Competing interests None.

    • Ethics approval Westat Institutional Review Board.

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