Real-Time Context of Tobacco Marketing Exposure and Community Vulnerability-An Ecological Momentary Assessment Among Young Adults

Julia C Chen-Sankey; Judy van de Venne; Susan Westneat; Basmah Rahman; Shanell Folger; Andrew Anesetti-Rothermel; Charles Debnam; Kurt M Ribisl; Amy Cohn; Shyanika W Rose

doi:10.1093/abm/kaab066

Real-Time Context of Tobacco Marketing Exposure and Community Vulnerability-An Ecological Momentary Assessment Among Young Adults

Ann Behav Med. 2022 Jun 29;56(6):620-631. doi: 10.1093/abm/kaab066.

Authors

Julia C Chen-Sankey¹, Judy van de Venne², Susan Westneat², Basmah Rahman³, Shanell Folger³, Andrew Anesetti-Rothermel^{2

4}, Charles Debnam⁵, Kurt M Ribisl⁶, Amy Cohn^{7

8}, Shyanika W Rose^{2

9}

Affiliations

¹ Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
² Center for Health Equity Transformation, Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA.
³ Truth Initiative Schroeder Institute®, Washington, DC, USA.
⁴ Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, USA.
⁵ Community Wellness Alliance, Washington, DC, USA.
⁶ Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁷ TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
⁸ Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
⁹ Markey Cancer Center, University of Kentucky, Lexington, KY, USA.

Abstract

Background: Exposure to tobacco product marketing increases tobacco use among young adults, especially those from vulnerable communities (VCs).

Purpose: This study examined real-time tobacco marketing exposure among young adults from vulnerable and non-vulnerable communities using Ecological Momentary Assessment (EMA).

Methods: This study used EMA data to assess context (e.g., location and activity) of tobacco marketing exposure using four text-messaging surveys per day over 2 weeks. Young adult non-current tobacco users living in Washington, D.C. (n = 146; ages 18-24) recorded 5,285 surveys, including 20 participants (13.2%) from VCs with high proportions of lower income and racial/ethnic minorities, and high smoking rates. Unadjusted and adjusted multilevel logistic regressions were used to assess the associations between exposure to any and flavored tobacco marketing, VC residence, and real-time context.

Results: Fifty-nine participants (40.4%) reported at least one tobacco marketing exposure and recorded 94 exposure moments. In adjusted models, odds of exposure were higher among VC residents (AOR = 2.6, 95% CI = 1.2-5.4), in the presence of anyone using tobacco versus no use (AOR = 4.0, 95% CI = 2.4-6.7), at store/retail (AOR = 17.0, 95% CI = 6.4-44.8), or outside/in transit (AOR = 4.1, 95% CI = 2.1-7.8) versus at home. VC residence (AOR = 7.2, 95% CI = 2.3-22.2) was the strongest predictor of flavored tobacco marketing exposure among all covariates examined.

Conclusions: Young adults are predominantly exposed to tobacco marketing in their daily lives through retail advertisements. Young adults from VCs are at increased risks of seeing any tobacco and especially flavored tobacco marketing. Policies that curtail tobacco retailer density and advertisement displays may reduce overall and differential tobacco marketing exposure.

Keywords: Community health; Ecological momentary assessment; Flavored tobacco marketing; Health disparities; Tobacco marketing; Young adults.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
Research Support, N.I.H., Intramural

MeSH terms

Adolescent
Adult
Ecological Momentary Assessment*
Humans
Marketing
Nicotiana
Smoking
Tobacco Products*
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding