Adult recall of tobacco advertising on the Internet

Nicotine & Tobacco Research Volume 9, Number 11 (November 2007) 1103 1107 Adult recall of tobacco advertising on the Internet Mary Hrywna, Cristine D. Delnevo, M. Jane Lewis Received 24 August 2006; accepted 12 February 2007 This study examined the prevalence and characteristics of New Jersey adults who reported seeing tobacco products advertised on the Internet and described the means by which these products were advertised. Data were analyzed from the New Jersey Adult Tobacco Survey (NJATS), a repeated, cross-sectional, random-digit-dial telephone survey conducted with a statewide representative sample. We used logistic regression to determine factors associated with recall of tobacco Internet advertising, adjusting for demographics, smoking behavior variables, and receipt of tobacco industry direct mail. Participants included 3,930 adults who completed the 2001 NJATS, 4,004 adults who completed the 2002 survey, and 3,062 adults who completed the 2005 survey. The proportion of adult Internet users reporting exposure to tobacco product advertising on the Internet has increased each year (6.9% in 2001, 15.6% in 2002, 17.8% in 2005). Based on 2005 data, recall of tobacco product advertising on the Internet was higher among males young adults aged 18 24 years, Asians, adults who reported receipt of direct mail advertising, and adults with a postcollege education. In addition, adult Internet users most often reported seeing tobacco products advertised on the Internet via pop-up or banner ads (60.7%), followed by E-mail messages (24.6%), and Web sites (14.9%). Recall of tobacco advertising by Internet users increased between 2001 and 2005 and was particularly high among certain subgroups. An urgent need exists for expanded surveillance of Internet tobacco sales and marketing practices. Introduction Previous research suggests that tobacco marketing and advertising affects smoking initiation and consumption (Biener & Seigel, 2000; Pierce, Choi, Gilpin, Farkas, & Berry, 1998; Saffer & Chaloupka, 1999). The Internet is an electronic medium that offers the tobacco industry an expansive and powerful marketing vehicle that is still largely unregulated. U.S. law prohibits advertising for cigarettes, little cigars, smokeless tobacco, or chewing tobacco on any medium of electronic communication under the jurisdiction of the Federal Communications Commission (FCC), such as television or radio (15 U.S.C. Sect. 1331 1341; 15 U.S.C. Sect. 4401 4408). Although this provision could arguably be interpreted to include a ban on Internet advertising of tobacco, the FCC has never Mary Hrywna, M.P.H., Cristine D. Delnevo, Ph.D., M.P.H., M. Jane Lewis, Dr.P.H., University of Medicine and Dentistry of New Jersey, School of Public Health, New Brunswick, NJ. Correspondence: Mary Hrywna, M.P.H., Instructor, University of Medicine & Dentistry of New Jersey School of Public Health, 317 George Street, Suite 209, New Brunswick, NJ 08901, USA. Tel: +1 (732) 235-9728; Fax: +1 (732) 235-9777; E-mail: hrywnama@umdnj. edu asserted its authority in this venue. The law enforcement activities of the Federal Trade Commission (FTC) also include monitoring tobacco advertising, but the FTC s power is limited to claims of unfair practices or false and deceptive advertising. To date, no U.S. agency has directly regulated the advertising of tobacco on the Internet. Any existing limits on tobacco Internet advertising to U.S. consumers are largely self-imposed. Several major tobacco companies, including Philip Morris International and British American Tobacco, implemented an international marketing code that claims they will not place advertisements on the Internet unless measures are in place that restrict access to adults and to those in countries permitting tobacco advertising (British American Tobacco, 2001; Philip Morris International, 2005). The advertising of tobacco products on the Internet has been promulgated mainly in two ways: the major tobacco manufacturers corporate and brand-specific Web sites and the Web sites of vendors promoting tax-free or low-priced cigarettes for sale online. All the major companies have company Web sites. In addition, R. J. Reynolds has created extensive brand-specific Web sites to ISSN 1462-2203 print/issn 1469-994X online # 2007 Society for Research on Nicotine and Tobacco DOI: 10.1080/14622200701488442

1104 ADULT RECALL OF TOBACCO ADVERTISING ON THE INTERNET advertise its products and offers interactive games, activities, and message boards to registered smokers as well as E-mail updates and direct mail coupons (Lewis & Wackowski, 2006). In the FTC s annual report on U.S. cigarette sales and advertising, tobacco companies reported spending $2.9 million on advertising on a company Internet Web site in 2003, three times the $940,000 reported in 2002 (FTC, 2005). The substantial increase in this category of advertising expenditures suggests that the major tobacco companies have recognized the Internet as an important medium for marketing. The Internet also is home to online vendors of tobacco products. Indeed, higher cigarette prices at retail stores and the subsequent growth of small, independent vendors selling low-priced cigarettes online has created a particularly large volume of tobacco advertising at the virtual point of sale as well as in the form of banner ads and unsolicited E-mails. Ribisl, Kim, and Williams (in press) estimated that in 2004 there were 775 U.S. and international Web sites selling cigarettes. The percentage of adults and youth buying cigarettes online is still small but growing in some regions (Fix et al., 2006; Hrywna, Delnevo, & Staniewska, 2004). For example, in New Jersey the percentage of current cigarette smokers who reported usually buying cigarettes online increased from 0.8% in 2000 to 3.1% in 2002 (Hrywna et al., 2004). Various measures have been implemented to prevent the illegal sale of untaxed cigarettes online including a voluntary agreement by major credit card and package delivery companies to no longer take part in online tobacco purchases (Office of New York State Attorney General, 2005, 2006; Tedeschi, 2005). But in the absence of a total ban on Internet tobacco sales, these Web sites are likely to remain readily available. As a result, people will continue to be exposed to tobacco advertising on the Internet. Previous published studies have examined tobacco Web sites by estimating the number of sites selling cigarettes or examining the content of pro-tobacco messages available on the Internet (Hong & Cody, 2002; Ribisl, Kim, & Williams, 2001; Ribisl, Lee, Henriksen, & Haladjian, 2003). To date, no published study has examined the level of awareness or recall of tobacco product advertising by Internet users. Accordingly, we sought to examine awareness of Internet tobacco advertising among New Jersey adults, determine the characteristics of adults who reported seeing these advertisements, and describe the means by which tobacco products were advertised. Method Data are from the New Jersey Adult Tobacco Survey (NJATS), a repeated, cross-sectional survey monitoring tobacco use behavior, knowledge, and attitudes. The NJATS uses a random-digit-dial telephone survey designed to oversample for young adults (aged 18 24), current smokers, and recent quitters. The data reported here are from the NJATS conducted in 2001, 2002, and 2005 (the NJATS was not conducted in 2003 or 2004). Of adults selected, 79.4% completed the interview in 2001, 50.4% in 2002, and 52.9% in 2005. A total of 3,930 adults completed the 2001 NJATS, 4,004 adults completed the 2002 survey, and 3,062 adults completed the 2005 survey. For each survey year, we estimated the prevalence of having ever seen tobacco products advertised on the Internet among adults with Internet access and among all adults, with or without Internet access. In 2001, survey participants were asked, Do you have access to the Internet at home, school, or work? In 2002 and 2005, participants were asked, Have you ever used the Internet? For the aims of this study, participants who answered affirmatively to either of these questions were categorized as having Internet access. Overall rates of Internet access among survey participants were similar across years, 66.3%, 67.4%, 69.1% (weighted), respectively. Only adults with Internet access were then asked, Have you ever seen tobacco products advertised on the Internet? To estimate the overall prevalence of adults who recalled tobacco advertising on the Internet, analyses were then conducted among all New Jersey adults and those without Internet access were counted as not having seen tobacco advertised on the Internet. We examined recall of tobacco Internet advertising by gender, race/ethnicity, age, smoking status, receipt of direct mail, and education. Respondents were identified as current smokers if they reported smoking at least 100 cigarettes in a lifetime and if they currently smoked every day or some days. Receipt of direct mail was measured by asking respondents if they had received mail from a tobacco company within the past 6 months. In addition, in 2005, adults who reported seeing tobacco products advertised on the Internet were then asked to indicate where they saw these products advertised (e.g., E- mail messages, pop-up messages, banner ads, Web sites). Sample weights were applied to adjust for nonresponse and the varying probabilities of selection, including those resulting from oversampling, providing results representative of New Jersey s adult population. SUDAAN statistical software, which corrects for complex survey design, was used to generate 95% confidence intervals (Research Triangle Institute, 2005). Differences between estimates were considered statistically significant at a p level of.05 if the 95% confidence intervals did not overlap. With data from only the 2005 NJATS, we used logistic

NICOTINE & TOBACCO RESEARCH 1105 Table 1. Percentage of adults having ever seen tobacco products advertised on the Internet, 2001 2005 NJATS. NJATS year Adults with Internet access All adults 2001 6.9 1.1 4.4 0.7 2002 15.6 3.1 10.0 1.6 2005 17.8 2.3 12.2 1.6 Note. Data are presented in percentages with 95% confidence intervals based on the weighted data. regression to assess the independent association of the factors predictive of recall of tobacco Internet advertising. Adjusted odds ratios and their 95% confidence intervals are presented. Results As shown in Table 1, the percentage of adults with Internet access who reported having seen tobacco products advertised on the Internet increased significantly between 2001 (6.9%) and 2002 (15.6%). Recall increased significantly from 6.9% in 2001 to 17.8% in 2005, an increase of 158%. We found no significant increase between 2002 and 2005 in the percentage of adults with Internet access who reported having seen tobacco products advertised on the Internet. Overall, 12.2% of all adults reported seeing tobacco Internet advertising in 2005. Table 2 presents the prevalence and adjusted odds ratio of having ever seen tobacco products advertised on the Internet, among both adults with Internet access and all adults. Males had significantly greater odds than females of reporting that they had seen Internet tobacco advertising. Race/ethnicity was also a strong predictor of ever having seen Internet tobacco advertising: Asians were roughly two times as likely as Whites to have reported seeing Internet tobacco advertising. Recall of Internet tobacco advertising was significantly higher among young adults aged 18 24 compared with all other age groups. Another strong predictor of having seen tobacco products advertised on the Internet was receipt of direct mail. Adults who reported receiving mail from a tobacco company had approximately three times the odds of ever seeing tobacco Internet advertising compared with adults who did not receive direct mail. Finally, adults with at least some graduate education had significantly greater odds of having seen tobacco products advertised on the Internet compared with adults without a college degree. Among all adults, those with a college degree were significantly more likely than those without a college degree to have seen Internet tobacco advertising, but this difference did not reach statistical significance among adults with Internet access only. Current smokers also reported high recall of Internet Table 2. Prevalence and adjusted odds ratio of having ever seen tobacco products advertised on the Internet, 2005 NJATS. Characteristic Adults with Internet access, N52,172 a Percent Adjusted odds ratio b (95% Confidence interval) c Percent All adults, N53,062 a Adjusted odds ratio b (95% Confidence interval) c Gender Male 22.3 1.62 (1.19 2.21) 15.5 1.53 (1.12 2.07) Female 13.9 1.00 (1.00 1.00) 9.3 1.00 (1.00 1.00) Race/ethnicity White 16.1 1.00 (1.00 1.00) 11.9 1.00 (1.00 1.00) Black 19.5 1.37 (0.85 2.20) 11.0 1.03 (0.65 1.64) Hispanic 24.3 1.57 (0.93 2.63) 11.6 0.92 (0.55 1.53) Asian 29.0 2.05 (1.07 3.93) 25.5 1.94 (1.02 3.69) Other 18.2 1.06 (0.53 2.10) 12.0 0.91 (0.47 1.77) Age group (years) 18 24 37.1 1.00 (1.00 1.00) 30.9 1.00 (1.00 1.00) 25 44 17.0 0.32 (0.22 0.46) 14.1 0.32 (0.22 0.47) 45 64 13.5 0.26 (0.17 0.39) 9.6 0.21 (0.14 0.32) 65+ 8.4 0.17 (0.08 0.36) 2.3 0.06 (0.03 0.11) Smoking status Current smoker 25.9 1.28 (0.86 1.91) 19.3 1.26 (0.86 1.86) Nonsmoker 15.9 1.00 (1.00 1.00) 10.7 1.00 (1.00 1.00) Received direct mail Yes 31.8 2.96 (2.03 4.32) 24.2 3.19 (2.21 4.60) No 14.1 1.00 (1.00 1.00) 9.5 1.00 (1.00 1.00) Education No college 17.6 1.00 (1.00 1.00) 10.6 1.00 (1.00 1.00) College degree 16.8 1.17 (0.81 1.69) 15.1 1.46 (1.01 2.12) Postcollege education 19.7 1.58 (1.01 2.49) 18.0 2.10 (1.33 3.31) Overall 17.8 12.2 Note. a Unweighted sample size. b Adjusted for all variables presented in the table. c Confidence intervals that do not include 1.0 indicated significance at the p,.05 level.

1106 ADULT RECALL OF TOBACCO ADVERTISING ON THE INTERNET tobacco advertising compared with nonsmokers, but these differences were not statistically significant. Adults who reported having ever seen tobacco products advertised on the Internet were asked where they had seen these products advertised. These adults most often reported seeing tobacco products advertised on the Internet via pop-up or banner ads (60.7%), followed by E-mail messages (24.6%) and Web sites (14.9%). Discussion Recall of tobacco advertising on the Internet among adults in New Jersey remains low (12.2%). However, recall of Internet tobacco advertising increased considerably between 2001 and 2005 and is particularly high among certain population groups including males, young adults, Asians, those who receive direct mail, and adults with a postcollege education. Recall or exposure to tobacco Internet advertising among these groups is likely to be influenced heavily by the amount of time spent online. As such, our results may be explained partially by the existing demographic differences in Internet use. For example, in the United States, men log on more often and spend more time online than women, and Asian Americans are the heaviest daily users of the Internet, staying connected longer than any other English-speaking ethnic group (Fallows, 2005; Spooner, 2001). Additionally, both the number of Web sites selling cigarettes and the advertising dollars spent on tobacco company Internet Web sites has grown dramatically (FTC, 2005; Ribisl et al., in press). In sum, the increased recall of Internet tobacco advertising is likely attributable to increased online marketing efforts by tobacco manufacturers and vendors, adults spending more time online, or a combination of these factors. Our study found the highest levels of recall of Internet tobacco advertising among young adults aged 18 24 (37.1% among those with Internet access, 30.9% among all young adults). Surveys of youth point to similarly high levels of awareness. In the United States, 34.1% of middle school students and 39.2% of high school students reported seeing advertisements for tobacco products on the Internet (Centers for Disease Control and Prevention, 2005). These findings also are likely to be influenced by the amount of time that these young people spend online. In the United States, 87% of youth aged 12 17 use the Internet and 51% of adolescent Internet users say they go online on a daily basis (Lenhart, Madden, & Hitlin, 2005). Receipt of direct mail was the strongest predictor of having ever seen Internet tobacco advertising. Mail from a tobacco company could include direct mail from a major company to registered smokers in its database as well unsolicited mail (e.g., coupon mailers) from Internet tobacco vendors. It may be that adults who recall tobacco advertising on the Internet are simply more engaged in or motivated to look for these promotions and, thus, have an increased awareness of Internet tobacco advertising. Certain limitations should be considered in interpreting the results of our study. First, the survey did not measure the amount of time that Internet users spend online. Future research should include a similar analysis of heavy Internet users versus those using the Internet less. Also, the survey question addressing Internet access was changed in 2002. Although rates of reported Internet access were similar across years, differences in wording could affect survey estimates. In addition, we did not ask respondents to identify the advertiser and so we are not able to determine whether the tobacco product advertising originated from a tobacco manufacturer or an Internet tobacco vendor. We also did not assess the type of tobacco product advertised (e.g., cigarettes, cigars, or other tobacco products). Additionally, the data are based on self-report, which may be subject to under- or over-reporting. Finally, we caution against generalizing these results beyond adults who reside in New Jersey. The Internet has created enormous advertising and marketing opportunities for the tobacco industry, both for tobacco companies promoting their brands and for smaller vendors selling tobacco products online. As access to the Internet increases, more people will be exposed to tobacco product advertising. Development of new policies and expansion of existing laws can and should include tobacco advertising on the Internet. Partial restrictions on advertising will allow the tobacco industry to exploit a medium like the Internet, where global visibility is high and control is murky. As such, states and countries cannot act in isolation to control tobacco advertising and marketing. Global agreements, such as the Framework Convention on Tobacco Control (FCTC), will play a crucial role in eliminating crossborder sales, advertising, and promotion of tobacco products. As of November 2006, more than 140 countries become parties to the FCTC, but the United States has yet to ratify the treaty (FCTC, 2006). Policymakers also must be wary of backdoor methods such as Web sites that are not directly linked to specific brands or tobacco and that appear only to offer or promote other products, entertainment venues, and the like ( BAT s Internet marketing plan, 2001; Harper, 2001; Simpson, 2002). We have yet to determine the true scope and reach of Internet tobacco advertising. An urgent need exists for expanded and ongoing surveillance of Internet tobacco sales and marketing practices. Future research should establish the prevalence of Internet

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