Direct Mail Marketing Influence on Tobacco Use Disorder

Overseen By Tsz Chun Choi, Ph.D.

Age: 18 - 65

Sex: Any

Trial Phase: Academic

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 All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

530 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to understand how cigarette direct mail marketing affects young adults' beliefs, responses, and arousal regarding smoking. Researchers are exploring differences in reactions between smokers from higher and lower socioeconomic backgrounds. Participants will view various marketing images, some with discount coupons and some without, to assess how these elements influence smoking behavior. Ideal participants are adults aged 18 to 29 who smoke daily and have smoked at least 100 cigarettes in their lifetime. As an unphased study, this trial allows participants to contribute to important research that could shape future marketing regulations and public health strategies.

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.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that exposure to tobacco ads, particularly those with discount coupons, correlates with increased smoking and reduced quitting. For instance, one study found that recipients of tobacco coupons were more likely to start smoking and less likely to quit. These marketing tactics can influence smoking habits.

When people encounter smoking ads without coupons, studies indicate they may feel more tempted to try smoking. While these ads don't always lead to immediate smoking, they can increase interest over time.

The trial also examines non-health-related images, which is generally safe. However, it is crucial to remember that secondhand smoke, often discussed in tobacco contexts, poses serious health risks, such as heart and lung diseases.

Overall, this trial observes how different ads affect smoking behaviors, rather than testing a new drug or treatment. The primary focus is on how advertising might influence smoking habits, not on physical safety. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how different types of direct mail marketing might influence tobacco use disorder. Unlike standard methods like counseling or nicotine replacement therapies, this trial examines whether exposure to smoking advertisements, with or without discount coupons, can impact smoking behavior. By comparing these approaches to non-health-related imagery, the trial seeks to uncover the psychological and behavioral effects of marketing on smoking habits. This could offer new insights into how advertising strategies contribute to tobacco use, potentially leading to innovative prevention methods.

What evidence suggests that this trial's treatments could be effective for influencing tobacco use disorder?

Research has shown that direct mail marketing, such as tobacco coupons, can increase the likelihood of young adults starting to smoke regularly. In this trial, participants will encounter various marketing materials. One study found that receiving tobacco coupons made quitting smoking more difficult. Another study noted that exposure to tobacco marketing raises the risk of starting to smoke, particularly among young adults. Even general tobacco ads, without coupons, can increase interest in trying tobacco products. Overall, these studies suggest that tobacco marketing strongly encourages smoking behavior. ^{1 2 6 7 8}

Who Is on the Research Team?

Tsz Chun Choi, Ph.D.

Principal Investigator

National Institute on Minority Health and Health Disparities (NIMHD)

Are You a Good Fit for This Trial?

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

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.

I can understand and am willing to sign the consent form.

Exclusion Criteria

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

I am a high school student.

I understand and can follow the study's requirements.

Timeline for a Trial Participant

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

What Are the Treatments Tested in This Trial?

Interventions

• Exposure to non health related images
• Exposure to smoking advertising with coupon
• Exposure to smoking advertising without coupons

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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 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]

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]

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]

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]

Citations

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Awareness of health effects of exposure to secondhand ... The most common health effects of secondhand smoke the respondents had highest awareness were lung cancer, precipitation of asthmatic attacks, and delivery of ...

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Effectiveness of warning graphic labels on cigarette packs ... The results revealed that non-smoking participants reported high perceived health risks associated with smoking behaviours when seeing all six types of warning ...

3. nature.com nature.com/articles/s41591-023-02743-4

Health effects associated with exposure to secondhand ... We conservatively estimated that SHS increases the risk of ischemic heart disease, stroke, type 2 diabetes and lung cancer by at least around 8%, 5%, 1% and 1% ...

4. cdc.gov cdc.gov/tobacco/secondhand-smoke/health.html

Health Problems Caused by Secondhand Smoke Exposure to secondhand smoke has immediate harmful effects on the heart and blood vessels and can cause coronary heart disease and stroke.

5. sciencedirect.com sciencedirect.com/science/article/pii/S2589004225002457

Observational studies of exposure to tobacco and nicotine ... Non-randomized observational studies can track risk-induction and -reduction associated with real-world use of non-combusted nicotine and ...

6. tobaccoatlas.org tobaccoatlas.org/challenges/secondhand-smoke/

Secondhand Smoke Risks, Effects & Statistics It can cause severe and fatal diseases, including cancer, cardiovascular disease, respiratory infections, and adverse reproductive effects.

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Tobacco There is no safe level of exposure to second-hand tobacco smoke. Second-hand smoke causes serious cardiovascular and respiratory diseases ...

8. hhs.gov hhs.gov/sites/default/files/2024-sgr-tobacco-related-health-disparities-fact-sheet.pdf

Tobacco-Related Health Disparities Fact Sheet Disparities in secondhand smoke exposure by race, poverty status, and education level have increased. 1 Tobacco referenced in this fact sheet refers to ...