Direct Mail Marketing Influence on Tobacco Use Disorder

Recruiting in Palo Alto (17 mi)

Overseen by Kelvin C Choi, Ph.D.

Age: 18 - 65

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: National Institute on Minority Health and Health Disparities (NIMHD)

Must not be taking: Recreational drugs

Disqualifiers: High school, Eye conditions, Epilepsy, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

Background: Smoking is a major public health problem in the U.S. Almost a half a million Americans die from it in a year. One thing that contributes to why people smoke is the marketing of cigarettes. Cigarette direct mail marketing usually targets young smokers of lower socioeconomic status. Researchers want to find out more about how this kind of marketing influences smoking behavior in young people from different socioeconomic levels. Objectives: To study the effects of cigarette direct mail marketing on beliefs, responses, and arousal. To study how these things may differ among young adult smokers of high and low socioeconomic status. Eligibility: Volunteer adults ages 18 to 29 who smoke. Design: Participants will have 1 visit. Participants will be asked questions about their health and recent smoking. A nurse will check their vital signs. Participants will have a simple eye exam. They will give blood and urine samples. Participants will be connected to equipment. This will collect data while they look at pictures. Then they will have a 10-minute break. A nurse will observe them during the break. Participants will have their breath analyzed. Participants will answer questions. The topics will include: Education Job Income Family history Tobacco use Exposure to pro-smoking and anti-smoking messages History of drug and alcohol use

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, you should not use alcohol, recreational drugs, or prescription medications for recreational purposes within 12 hours before the study visit.

What data supports the effectiveness of the treatment 'Exposure to smoking advertising with coupon' for Tobacco Use Disorder?

Research shows that smokers who receive tobacco coupons via direct mail are more likely to redeem them, which suggests that this marketing strategy can influence smoking behavior. This indicates that exposure to smoking advertising with coupons may increase smoking behavior, highlighting the need for restrictions on coupon redemption to encourage quitting. ^{1 2 3 4 5}

Is exposure to tobacco direct mail marketing safe for humans?

The research does not provide specific safety data on exposure to tobacco direct mail marketing, but it does suggest that such marketing can influence smoking behaviors, which may have health implications. ^{2 5 6 7 8}

How does direct mail marketing influence tobacco use disorder treatment?

This treatment is unique because it focuses on the influence of direct mail marketing strategies, such as coupons and advertisements, on smoking behaviors rather than a traditional medical or therapeutic approach. It examines how exposure to these marketing tactics can affect smoking habits, potentially increasing tobacco use or hindering quitting efforts. ^{1 2 5 7 8}

Research Team

Kelvin C Choi, Ph.D.

Principal Investigator

National Institute on Minority Health and Health Disparities (NIMHD)

Eligibility Criteria

This trial is for young adult smokers aged 18 to 29, who smoke daily and have smoked over 100 cigarettes in their lifetime. Participants should be generally healthy, able to understand English, and either have a high socioeconomic status (enrolled in or graduated from college) or low socioeconomic status (no four-year degree, born in the US, income under $50k).

Inclusion Criteria

I am between 18 and 29 years old.

SES: For the purpose of the study, two groups are chosen based on their social determinants and prevalence of smoking - Low SES: Young adults who do not have a four-year college degree, are not currently enrolled in a four-year college, were born in the US, and have an annual income less than $50,000. High SES: Young adults who are currently enrolled in or graduated from a four-year college

I am generally healthy or have chronic conditions that are well managed.

Exclusion Criteria

I am a high school student.

Inability to see an object located between 15 to 27 inches away from them even with corrective contact lenses.

I understand and can follow the study's requirements.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

1 day

1 visit (in-person)

Part 1 - Pilot Data Collection

Participants provide biospecimens and are shown images on a computer to collect pilot data on smoking behavior influences

1 day

1 visit (in-person)

Part 2 - Randomized Comparative Trial

Participants are randomized to view direct mail marketing materials with or without discount coupons to study their effects on beliefs, responses, and arousal

1 day

1 visit (in-person)

Follow-up

Participants are monitored for any changes in smoking behavior and responses after the trial

4 weeks

Treatment Details

Interventions

• Exposure to non health related images (Behavioural Intervention)
• Exposure to smoking advertising with coupon (Behavioural Intervention)
• Exposure to smoking advertising without coupons (Behavioural Intervention)

Trial Overview The study aims to understand how cigarette direct mail marketing affects smoking behaviors among young adults of varying socioeconomic statuses. It involves exposure to different types of smoking advertisements and observing participants' responses.

Participant Groups

Group I: 4/Part 2 - Control Experimental Treatment 1 Intervention

Randomized to view direct mail marketing

Group II: 3/Part 2 - No Discount Coupons Experimental Treatment 1 Intervention

Randomized to view direct mail marketing

Group III: 2/Part 2 - Discount Coupons Experimental Treatment 1 Intervention

Randomized to view direct mail marketing

Group IV: 1/Part 1 Experimental Treatment 1 Intervention

60 Participants of high and low SES

Who Is Running the Clinical Trial?

National Institute on Minority Health and Health Disparities (NIMHD)

Lead Sponsor

Trials

473

Recruited

1,374,000+

Dr. Eliseo J. Pérez-Stable

National Institute on Minority Health and Health Disparities (NIMHD)

Chief Executive Officer since 2015

MD from University of Miami

Dr. Rada Dagher

National Institute on Minority Health and Health Disparities (NIMHD)

Chief Medical Officer since 2024

MD from University of California, San Francisco

Findings from Research

The study found that adult participation in tobacco industry direct marketing, particularly through direct mail, was highest among current smokers, Whites, and individuals aged 25 to 64 years.

Tobacco industry marketing strategies are likely to not only influence smoking initiation but also increase consumption and hinder efforts to quit smoking.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tobacco industry direct mail marketing and participation by New Jersey adults. Lewis, MJ., Delnevo, CD., Slade, J.[2019]

In a study of 32,160 US adults, receiving direct mail or email tobacco coupons was linked to a higher likelihood of nonsmokers starting to smoke (AOR = 1.76) and current smokers continuing or increasing their smoking habits (AOR = 1.34 for continuation and AOR = 1.70 for daily smoking).

The findings suggest that direct-to-consumer tobacco marketing strategies, like coupon distribution, may significantly influence smoking behaviors, highlighting the need for further research and potential regulation to protect public health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Receipt of Tobacco Direct Mail Coupons and Changes in Smoking Status in a Nationally Representative Sample of US Adults. Choi, K., Soneji, S., Tan, ASL.[2019]

About 25% of young adult smokers reported receiving direct mail from tobacco companies, and 24% used coupons to buy cigarettes, indicating that these marketing strategies are prevalent among this group.

The study found that females, daily smokers, and white individuals had higher rates of receiving direct mail and using coupons, suggesting that these tactics may be particularly effective in promoting smoking among young women.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tobacco industry direct mail receipt and coupon use among young adult smokers. Jane Lewis, M., Bover Manderski, MT., Delnevo, CD.[2022]

In a study of 10,994 adult smokers, 22% received tobacco coupons via email and 32% via mail, with 22% redeeming these coupons, highlighting the effectiveness of direct marketing strategies by tobacco companies.

Demographic factors such as being a white, 25-44 year old female, or having mid-level education were associated with higher rates of coupon receipt and redemption, suggesting that targeted restrictions on coupon use could help reduce smoking rates among vulnerable populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Receipt of direct tobacco mail/email coupons and coupon redemption: Demographic and socioeconomic disparities among adult smokers in the United States. Osman, A., Queen, T., Choi, K., et al.[2020]

In a study of 2622 young adults, exposure to tobacco direct mail marketing was linked to an increase in smoking behaviors, with 13% of participants reporting receipt of such materials.

Receiving cigarette coupons in the mail was associated with a higher likelihood of nonsmokers and ex-smokers becoming current smokers, and it decreased the chances of current smokers quitting, suggesting that regulating this marketing could help reduce smoking rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Frequency and characteristics associated with exposure to tobacco direct mail marketing and its prospective effect on smoking behaviors among young adults from the US Midwest. Choi, K., Forster, JL.[2022]

Graphic warning labels on cigarette advertisements significantly reduce visual attention to the ads and increase negative emotional responses compared to text-only warnings, as shown in studies with 474 middle-school youth and 451 adult smokers.

These graphic warnings also decrease the appeal of cigarette brands among youth, suggesting they could be an effective tool in preventing smoking initiation, although they did not change health risk beliefs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using graphic warning labels to counter effects of social cues and brand imagery in cigarette advertising. Niederdeppe, J., Kemp, D., Jesch, E., et al.[2020]

Cumulative exposure to cigarette discount coupons significantly increases the likelihood of smoking among adults who have never smoked, with each additional wave of exposure doubling the odds of becoming a current smoker.

For daily smokers, exposure to these coupons decreases the chances of quitting smoking, while also increasing the likelihood of relapse among those who had previously quit, particularly affecting women and individuals with lower socioeconomic status.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cumulative cigarette discount coupon exposure and trajectories of cigarette smoking: a longitudinal analysis in US adults. Hamilton-Moseley, KR., McNeel, TS., Choi, K.[2023]

A staggering 96% of direct-mail tobacco advertisements included price incentives, which can undermine the effectiveness of tobacco taxes designed to reduce usage.

40% of all tobacco ads featured themes appealing to youth and young adults, particularly in electronic nicotine delivery systems (ENDS), raising concerns about the industry's compliance with regulations aimed at protecting vulnerable populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Content Analysis of Promotional Features in US Direct-Mail From Advertisements Across Tobacco Products From 2018 to 2020. Silver, N., Rahman, B., Folger, S., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

Tobacco industry direct mail marketing and participation by New Jersey adults. [2019]

2. England pubmed.ncbi.nlm.nih.gov

Receipt of Tobacco Direct Mail Coupons and Changes in Smoking Status in a Nationally Representative Sample of US Adults. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

Tobacco industry direct mail receipt and coupon use among young adult smokers. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Receipt of direct tobacco mail/email coupons and coupon redemption: Demographic and socioeconomic disparities among adult smokers in the United States. [2020]

5. United States pubmed.ncbi.nlm.nih.gov

Frequency and characteristics associated with exposure to tobacco direct mail marketing and its prospective effect on smoking behaviors among young adults from the US Midwest. [2022]

6. England pubmed.ncbi.nlm.nih.gov

Using graphic warning labels to counter effects of social cues and brand imagery in cigarette advertising. [2020]

7. England pubmed.ncbi.nlm.nih.gov

Cumulative cigarette discount coupon exposure and trajectories of cigarette smoking: a longitudinal analysis in US adults. [2023]

8. England pubmed.ncbi.nlm.nih.gov

A Content Analysis of Promotional Features in US Direct-Mail From Advertisements Across Tobacco Products From 2018 to 2020. [2023]