Direct-to-consumer tobacco marketing and its association with tobacco use among adolescents and young adults

J Adolesc Health. 2014 Aug;55(2):209-15. doi: 10.1016/j.jadohealth.2014.01.019. Epub 2014 Mar 21.


Objective: We assess exposure to direct-to-consumer tobacco marketing and its association with ever having tried smoking, smoking within past 30 days (current), and smoking ≥100 cigarettes in lifetime (established) among adolescents and young adults.

Methods: We surveyed a U.S. telephone sample of 3,342 15- to 23-year-olds and 2,541 respondents subsequently completed a web-based survey. Among respondents completing both the telephone and web-based surveys (N = 2,541 [75%]), we assessed their exposure to direct-to-consumer tobacco marketing (receiving direct mail from tobacco companies and seeing tobacco company websites) and their associations with ever having tried smoking, current smoking, and established smoking.

Results: Overall, 12% of 15- to 17-year-olds and 26% of 18- to 23-year-olds were exposed to direct-to-consumer tobacco marketing. Racial/ethnic minority nonsmoking respondents were more likely to see tobacco websites than nonsmoking whites. Respondents exposed to either form of direct-to-consumer tobacco marketing were more likely to currently smoke (adjusted odds ratio 2.2, 95% confidence interval 1.3-3.8), while those exposed to both forms of marketing experienced even higher odds of currently smoking (adjusted odds ratio 2.7, 95% confidence interval 1.1-6.6). We observed similar relationships for ever having tried smoking and established smoking.

Conclusions: Direct-to-consumer tobacco marketing reaches adolescent and young adult nonsmokers and is associated with smoking behavior.

Keywords: Adolescents; Direct-to-consumer marketing; Tobacco; Young Adults.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Age Factors
  • Confidence Intervals
  • Consumer Behavior*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Incidence
  • Male
  • Marketing / methods*
  • Odds Ratio
  • Risk Assessment
  • Sex Factors
  • Smoking / epidemiology*
  • Surveys and Questionnaires
  • Tobacco Industry / methods*
  • Tobacco Use / epidemiology
  • United States
  • Young Adult