Hidden tobacco marketing to youth: Exposure to tobacco coupons and its effects

Background: Tobacco companies have been using less visible channels such as discount coupons to reach youth. However, little is known about exposure and potential effect of this marketing strategy among youth.

Methods: We examined the prevalence of receiving tobacco coupons in the past 30 days among a US nationally representative sample of middle and high school students (n=24203). Characteristics of those who received these coupons and associations between receiving these coupons and psychosocial factors related to smoking were assessed. Weighted multivariate logistic regression models were used.   

Results: 13.5% of the sample (10.6% among non-smokers and 41.3% among smokers) reported receiving tobacco coupons in the past 30 days. Native Americans (vs. non-Hispanic Whites) and those who live with tobacco users (vs. not living with tobacco users) were more likely to have received these coupons (p<0.05). Youth who received these coupons, compared with those who did not receive, were less likely to agree that all tobacco products are dangerous. Youth non-smokers who received the coupons were more likely than those who did not to be susceptible to cigarette smoking (p<0.05).Youth smokers who received these coupons were less likely than those who did not to feel very confident in quitting cigarettes completely, but were more likely to have purchased cigarettes in the past 30 days (p<0.05). These associations were independent of exposure to tobacco advertising.

Conclusions: An unacceptably high proportion of US youth was exposed to tobacco coupons, and the exposure was associated with predictors of smoking initiation and cessation in youth.