Tobacco direct mail marketing and smoking behaviors in a cohort of adolescents and young adults from the U.S. upper midwest: A prospective analysis

Introduction: We assessed the characteristics of adolescents and young adults who received tobacco direct mail materials and the association of receiving these materials with subsequent smoking behaviors. Methods: Adolescents from the upper Midwest region of the United States were sampled through clustered random sampling in 2000 and surveyed every 6 months. Participants (n = 3546) were asked at baseline (October 2006-March 2007) whether they had received direct mail materials from tobacco companies during the previous 6 months. Smoking behaviors were assessed 6 months later (April-September 2007). We assessed associations between demographics and receiving tobacco direct mail materials at baseline and the association of receiving these materials with smoking behaviors at follow-up, stratified by baseline smoking status. Results: Overall, 5.2% of nonsmokers and 23.9% of current smokers in our sample received tobacco direct mail materials during the past 6 months (2.6% and 17.1% among nonsmokers and smokers <18 years old, respectively; p < .05). Participants who were older and living with smokers were more likely to receive these materials (p < .05). Baseline nonsmokers who received these materials smoked more cigarettes during the previous 30 days at follow-up (p < .05); baseline current smokers who received these materials were less likely than those who did not to reduce the number of cigarettes smoked during the past 30 days at follow up (p < .05). Conclusions: Those younger than 18 years old (particularly smokers) in addition to older individuals in our regional sample were exposed to tobacco direct mail marketing. Exposure to this market strategy is associated with faster escalation of cigarette consumption among nonsmokers and lower likelihood of smoking reduction among smokers in this adolescent and young adult sample.