A Content Analysis of Promotional Features in US Direct-Mail From Advertisements Across Tobacco Products From 2018 to 2020

Abstract

Introduction

Direct-mail advertising is a crucial channel through which tobacco companies deliver price incentives that lower the barrier to tobacco use while promoting tobacco products via thematic appeals not legally permitted on other marketing channels. We examine the prevalence of price incentives and ad characteristics used in tobacco product advertisements (ads) mailed directly to US consumers.

Aims and Methods

We analyzed the content of direct-mail tobacco ads (N = 1047) in circulation between January 2018 and December 2020 as captured by Mintel Comperemedia Direct. These ads were coded for product type, manufacturer/brand type, model characteristics, price incentives, and themes known to appeal to vulnerable subgroups.

Results

Ads across all tobacco products included price incentives (96%) and contained themes that appealed to rural white (40%) and black audiences (15%). Themes known to appeal to youth and young adults were present in 40% of ads across all products, including 78% of ads promoting electronic nicotine delivery systems (ENDS). Moreover, the ENDS ads featuring youth appealing themes (51%), also featured young models.

Discussion

Expanding on previous research which focused on combustible and smokeless tobacco products, this analysis examines direct-mail ads across the full range of tobacco products. Our findings highlight the need for regulations to address (1) the high prevalence of price incentives that undermine the effectiveness of excise taxes on tobacco use, and (2) ad themes and characteristics that appeal to groups vulnerable to tobacco use, both of which have the potential to further exacerbate tobacco-related health disparities.

Implications

This study reinforces the importance of examining direct-mail as the dominant medium for tobacco advertising, particularly by including coupons and discount codes that reduce product price and thus circumventing the effect of tobacco-related tax legislation. Direct-mail encourages continued product loyalty and use and engages new consumers using price incentives and advertising strategies likely to appeal to price-sensitive consumers and other vulnerable populations. Substantial use of youth-appealing elements in ENDS ads contradicts the tobacco industry’s mandate to not appeal to youth, warranting highlighting the gaps in current regulations that allows them to continue appealing to this population.

Introduction

While the 1998 Master Settlement Agreement (MSA)¹ and the 2009 Family Smoking Prevention and Tobacco Control Act² limited the ability of tobacco retailers and manufacturers to market their products overtly to youth through venues like billboards or radio advertisements (ads), they do not prohibit direct-mail marketing, which the industry continues to use to reach youth and other vulnerable populations.³ The Centers for Disease Control and Prevention estimates that the tobacco industry spends 8.2 billion dollars on advertising annually,⁴ the majority (70%) of which pay for price incentives and coupons in part delivered through direct-mail. Direct-mail advertising poses a persistent challenge to public health, as tobacco companies use advertising themes that appeal to vulnerable demographics including rural white, black, and youth or young adult populations.⁵ Moreover, such advertising poses a challenge to regulators in that it is largely hidden from public view.^3,5–7 Currently, direct-mail advertising offers a legally allowable avenue to promote a variety of tobacco products using themes deemed inappropriate for other advertising mediums alongside price incentives that remove crucial cost barriers to initiation and progression of tobacco use, delivered directly to the homes of vulnerable populations.

Direct-Mail Ad Characteristics

The content and themes associated with direct-mail ads may perpetuate disparities in tobacco-related mortality and morbidity. Tobacco companies have a well-documented history of targeting black populations through aggressive marketing that appropriates imagery indicative of African American culture (eg, hip hop).⁸ As a result, black populations have greater exposure to tobacco marketing and suffer disproportionately from the tobacco-related disease despite having a lower prevalence of smoking than their white counterparts.^8,9

Outside of appealing to African American culture, existing literature highlights a variety of other tailored ad strategies for specific tobacco products. For example, combustible cigarette (CC) ads commonly depict smoking as a way to socialize with others and regulate mood, and often associate use with the outdoors, leading to perceptions that the product is natural and offers reduced harm.⁵ Additionally, ads for electronic nicotine delivery systems (ENDS) including electronic cigarettes and heated tobacco products often depict innovative, more socially acceptable alternatives to conventional smoking,¹⁰ potentially appealing to youth who list curiosity as reason to use them.⁵ Ads for little cigars and cigarillos (LCC) often associate product use with creative or artistic appeals tied to music, urban, and nightlife settings—an effective way to appeal to young audiences.^5,11

Direct-mail marketing has also been shown to appeal to groups who use tobacco at higher rates.^5,12 For example, smokeless tobacco (SLT) ads frequently feature stereotypically masculine, blue collar, and outdoor themes which may contribute to disparities in use by rural, white, male adolescents.¹² Historically, tobacco companies have integrated promotional strategies that may also appeal to low-income women, such as point-of-sale discounts, developing new brands specifically for women, and promoting luxury images.^13–15 It is also important to note that although past legislation and settlements prohibit the overt advertising of tobacco products directly to youth through mediums designed with young people in mind (eg, cartoons), ads not intentionally targeted to young people may nonetheless appeal to them.¹⁶ There is strong evidence that lifestyle advertising highlighting status, success, social attractiveness, or using young models appeals to young people.¹⁰

Impact of Direct-Mail

Direct-mail coupons reduce prices significantly and effectively reduce barriers to access for price-sensitive populations, driving initiation, continued, and increased consumption of tobacco products among youth and young adults, regardless of smoking status.^17–21 From 2013 to 2014, 7.6% of US youth (aged 12–18 years), received tobacco discount coupons and 11.8% engaged with tobacco brands as a result.¹⁷ Such coupons have been shown to attract new consumers, encourage switching to new products, and increase consumption,^19,22 with differential impacts on tobacco use across ethnic and socioeconomic subpopulations.²² In 2018, price discounts and promotional allowances were the largest advertising and promotional expenditure categories reported by CC and SLT manufacturers.²³ This spending increases tobacco use, as those who receive direct-mail are more likely to use both cigarettes and snus,²⁴ and are seven times more likely to use coupons compared with those who do not receive direct-mail.²⁵ Direct-mail advertising couples the sort of appealing imagery and persuasive appeals used to market other, nonaddictive and carcinogenic consumer products with price-cutting incentives aiming to foster brand loyalty and increase consumption, posing additional risk to price-sensitive groups such as low-income individuals and youth.^{3,6,7,17,18,20}

Current Study

There is limited research on direct-mail tobacco marketing, particularly in terms of ad content. The most recent literature in this area examines the landscape of tobacco product marketing in SLTs promoted in the United States prior to 2018.^5,12 Moreover, though extensive research examines populations who use coupons and to what effect,²⁶ the relationship between direct-mail advertising and distribution of coupons and other price incentives is less clear. This research examines the prevalence of price incentives and ad characteristics used in ads promoting CCs, SLTs, LCCs, and ENDS mailed directly to US consumers between 2018 and 2020. This research also examines the prevalence of ad characteristics that are likely to appeal to vulnerable groups, as well as which brands are leveraging direct-mail advertising by addressing the following research questions:

RQ1: How prevalent are price incentives in direct-mail ads across products?

RQ2: What ad themes and characteristics are prevalent in direct-mail ads across products?

RQ3: How prevalent are ad characteristics that are likely to appeal to vulnerable groups such as rural white, black, youth and young adults?

RQ4: What brands produce the most direct-mail advertising?

Methods

Procedure

We conducted a content analysis of direct-mail ads sent between January 1, 2018 and December 31, 2020. Ads featured CCs, SLTs (including loose leaf, chew, dip, snuff, and newer products like snus), LCCs, and ENDS (including e-cigarettes and heat-not-burn products). Ads were coded for content, themes, and model characteristics shown by previous research to be appealing to audiences who are rural, white, black, youth, or young adults. Our methodology adhered to conventions for quantitative content analysis from Neudorf’s Content Analysis Guidebook.²⁷

Sample

We contracted with Mintel Comperemedia Direct,²⁸ an exhaustive database of direct-mail ads, to identify 3745 tobacco ads that circulated between 2018 and 2020. Mintel’s nationally representative panel of members are asked to scan copies of all ads they receive in the mail, which Mintel then categorizes for use in market-based analyses.²⁹ Although Mintel’s database is not a full census of all ads in circulation, their methodology includes demographic quota sampling by region that provides a near census accounting of all creatives in circulation at a given point in time. Thus, with individual ads as the unit of analysis, we treated the full database of ads as our sampling frame, and randomly sampled 1200 to assure that our coded sample was generalizable to the broader population of ads provided by the database. After removing premium cigar catalogs that were not associated with specific brands (n = 57), direct communications with customers such as customer service communications (n = 23), and duplicate ads (n = 73) our analyses were conducted on a final sample of N = 1047 ads (CCs: n = 590, SLTs: n = 379, LCCs: n = 22, ENDS: n = 51, and n = 5 ads promoting both CCs and either SLTs or ENDS products). Thus, the coded ads offer a representative sample of all direct-mail ads sent to US consumers in the previous three years.

Codebook Development and Content Coding

Our codebook was developed in consultation with both previous content analyses in this area^12,30 and based on literature on the demographic appeal of various advertising characteristics. Consistent with convention,²⁷ we reserved a random subsample of at least 10% of ads (n = 130) to establish reliability for our codebook. An initial a priori operationalization of each characteristic was specified for the first round of reliability coding (n = 25), after which discrepancies between three independent coders were resolved by group discussion, and then recoded. Following each round of coding, necessary clarifications were added to the codebook to avoid future discrepancies. We repeated this iterative process until a minimum acceptable reliability of Krippendorf’s alpha (α) > 0.70 was reached for the full reliability sample.³¹Table 1 provides reliability statistics and summary criteria for each coded thematic element organized by the demographic category to which each thematic element was likely to appeal. After a reliable codebook was developed, the remaining ads were divided evenly amongst the three coders.

Table 1.

Krippendorf’s Alpha Accessing Reliability of Coded Ad Characteristics With Summary of Criteria for Each Ad Characteristic

Aggregated category	Ad characteristic	Summary of criteria	α
Price incentives	Coupons	Presence of a physical coupon or explicit reference to “coupons inside”	0.99
	Web promotions	Presence of a referral to discounts, promotions, or rewards clubs online	1
Appeals to rural white audiences	Blue collar	Depicting trade vocations	1
	Rural	Depicting agrarian setting	0.93
	Outdoor recreation	Depicting outdoor recreational activities	0.94
	Tradition	Upholding the value of highlighting continuity between past and present	0.98
	Patriot	Depicting nationalistic pride for the United States or domestic manufacturing	1
Appeals to black audiences	Traditional black spaces	Depicting social constructs or settings associated with the US black experience	1
	Black creative spaces	Depicting creative activity associated with or by black artists	1
Appeals to youth and young adults	Social media	Presence of a referral to social media owned by the brand	0.97
	Rebellion/individuality	Depicting qualities or characteristics that aim to distinguish someone from others	1
	Satire	Expressing humor or exaggeration to draw attention the product	0.96
	Creative/artistic	Depicting creative activity	0.96
	Tech/innovation	Highlighting new technological features or rebranding efforts for a product	0.92
	Trendy/stylish	Depicting attire that would be considered fashionably modern or up to date	0.96
	Luxury destinations	Depicting sumptuous environments or extravagant living	1
	Social	Depicting positive social interaction	1
	Night out	Depicting scenes or activities associated with nightlife	1

Model Characteristics

The presence of models (α = 0.98) who were male (α = 0.98), female (α = 0.96), black (α = 1), East Asian (α = 0.91), other race/ethnicity (α = 0.97), and under 35 (α = 0.95) were identified. In two cases (black and young) model characteristics were used to infer whether an ad was appealing to the appropriate subgroup.

Price Reduction Incentives

We identified two kinds of pricing incentives including coupons provided as part of the ad and referrals to promotions, discounts, or rewards clubs online. Ads that explicitly mentioned “coupons inside” or that included physical coupons in the image were coded as having coupons. Other ads which included invites or referrals to websites (eg, “special offers on our website”) were coded as web promotions.

Ad Themes

Various themes indicative of an ad’s likely appeal to rural white, black, and youth and young adults were identified and aggregated. Individual themes were not mutually exclusive. For example, the same ad could have both outdoor and patriotic characteristics. Thus, when calculating the number of ads likely to appeal to our subgroups of interest, an ad having multiple characteristics was only counted one time in the aggregate count. Thus, an ad containing both outdoor and patriotic ad themes would only count as one ad appealing to a rural white demographic.

Themes likely to appeal to rural white audiences were identified based on previous research specifically focused on SLTs.¹² Ads featuring themes idealizing blue collar identity such as manufacturing or agricultural jobs, rural settings (eg, farmland) or outdoor recreational activities (eg, ATVs, fishing), and highlighting tradition (eg, “The way it’s always been”) or patriotism were coded as independent features.

We used a similar approach to identify ads likely to appeal to black populations, which included at least one of three characteristics: at least one black model, or one of two themes identified by previous research as indicative of African American culture²⁹ including depictions of traditionally black spaces like barber shops and jazz clubs or traditionally black creative spaces such as ads promoting street art, slam poetry, or hip-hop.

We coded a wide range of ad characteristics which can be considered to appeal to youth and young adults. We categorized ads as youth-appealing if they featured young models (clearly under 35), given that previous research suggests young models are most likely to evoke wishful identification and potential imitation by adolescents, particularly with age-restricted products like tobacco.³² Moreover, referrals to a brand’s social media were also deemed youth-appealing, as social media is a key means through which the tobacco industry facilitates brand engagement by young people.^33,34 We also tagged ads as youth-appealing if they included features shown by previous research to appeal to youth and young adults including rebellion and individuality, humor, arts and creativity, innovation or technology, luxury destinations, socializing, and night out.^10,35

Results

Table 2 provides descriptives for both coded and aggregate categories for the prevalence of price-incentives (RQ1), ad themes by product (RQ2), and the number of ads containing appeals to vulnerable subgroups (RQ3). Finally, Table 3 provides descriptives for the prevalence of specific brands by product (RQ4). A summary of findings is presented below.

Table 2.

Frequency of Ad Themes and Price Incentives by Product

Ad characteristics a	CC ads (N = 590)	SLT ads (N = 379)	LCC ads (N = 22)	ENDS ads (N = 51)	CC and SLT or ENDS ads (N = 5)
	n (%)	n (%)	n (%)	n (%)	n (%)
Price reduction incentives	574 (97.29)	356 (93.93)	21 (95.45)	51 (100.00)	5 (100.00)
Coupons	416 (70.51)	304 (80.21)	18 (81.82)	30 (58.82)	5 (100.00)
Web promotions	516 (87.46)	304 (80.21)	17 (77.27)	51 (100.00)	5 (100.00)
Appeals to rural white audiences	222 (37.63)	181 (47.76)	3 (13.64)	10 (19.61)	2 (40.00)
Blue collar	92 (15.59)	54 (14.25)	0 (0.00)	0 (0.00)	2 (40.00)
Rural	38 (6.44)	26 (6.86)	0 (0.00)	0 (0.00)	0 (0.00)
Outdoor	85 (14.41)	57 (15.04)	3 (13.64)	5 (9.80)	0 (0.00)
Tradition	85 (14.41)	90 (23.75)	0 (0.00)	0 (0.00)	1 (20.00)
Patriot	24 (4.07)	47 (12.40)	0 (0.00)	5 (9.80)	1 (20.00)
Appeals to black audiences	92 (15.59)	22 (5.80)	4 (18.18)	8 (15.69)	0 (0.00)
Traditional black spaces	8 (1.36)	0 (0.00)	2 (9.09)	1 (1.96)	0 (0.00)
Black creative spaces	8 (1.36)	0 (0.00)	1 (4.55)	5 (9.80)	0 (0.00)
Black models	86 (14.58)	22 (5.80)	4 (18.18)	2 (3.92)	0 (0.00)
Appeals to youth and young adults	264 (44.75)	108 (28.50)	11 (50.00)	40 (78.43)	1 (20.00)
Rebellion/individuality	47 (7.97)	7 (1.85)	0 (0.00)	3 (5.88)	0 (0.00)
Satire	9 (1.53)	21 (5.54)	0 (0.00)	0 (0.00)	0 (0.00)
Creative/artistic	24 (4.07)	6 (1.58)	1 (4.55)	11 (21.57)	1 (20.00)
Tech/innovation	4 (0.68)	2 (0.53)	0 (0.00)	27 (52.94)	0 (0.00)
Trendy/stylish	64 (10.85)	3 (0.79)	1 (4.55)	11 (21.57)	0 (0.00)
Luxury destinations	72 (12.20)	0 (0.00)	1 (4.55)	1 (1.96)	0 (0.00)
Social	92 (15.59)	46 (12.14)	4 (18.18)	8 (15.69)	0 (0.00)
Night out	52 (8.81)	10 (2.64)	2 (9.09)	3 (5.88)	0 (0.00)
Social media promotion	2 (0.34)	16 (4.22)	0 (0.00)	8 (15.69)	0 (0.00)
Young models	151 (25.59)	49 (12.93)	10 (45.45)	26 (50.98)	1 (20.00)

Section headers are an aggregation of subcategories wherein the presence of at least one of the items is required for an ad to be categorized in the bolded aggregate category. As a result, aggregate categories are not a simple sum, as themes are not mutually exclusive.

CC = combustible cigarettes; ENDS = electronic nicotine delivery systems; LCC = little cigars and cigarillos; SLT = smokeless tobacco.

Table 3.

Frequency of Brand by Product

CC ads (N =590)		SLT ads (N = 379)		LCC ads (N = 22)		ENDS ads (N = 51)		CC and SLT or ENDS ads (N = 5)
Brand	n (%)	Brand	n (%)	Brand	n (%)	Brand	n (%)	Brand	n (%)
Marlboro	168 (28.47)	SKOAL	91 (24.01)	Black & Mild	14 (63.64)	Vuse	22 (43.14)	Camel & Snus	3 (60.00)
Camel	78 (13.22)	Copenhagen	86 (22.69)	Cheyenne	4 (18.18)	Mark-Ten	12 (23.53)	Camel & Vuse	1 (20.00)
Newport	59 (10.00)	Grizzly	65 (17.15)	Swisher Sweets	2 (9.09)	IQOS	6 (11.76)	Red Seal & Winston	1 (20.00)
Natural American Spirits	53 (8.98)	RedMan/LongHorn/Timber Wolf	42 (11.08)	Criss-Cross Smooth	1 (4.55)	JUUL	6 (11.76)
Winston	53 (8.98)	Red Seal	41 (10.82)	Night Owl Cigars	1 (4.55)	blu	2 (3.92)
Kool	43 (7.29)	Camel Snus	21 (5.54)			Leap Vapor	1 (1.96)
Virginia Slims	30 (5.08)	on!	14 (3.69)			Tahoe	1 (1.96)
Pall Mall	25 (4.24)	General Snus	7 (1.85)			logic	1 (1.96)
L&M	20 (3.39)	Verve	4 (1.06)
Parliament	18 (3.05)	REVEL	3 (0.79)
Nat’s Naturals	16 (2.71)	Stoker’s	3 (0.79)
Benson & Hedges	8 (1.36)	Velo	2 (0.53)
Chesterfield	6 (1.02)
Maverick	4 (0.68)
Bugler	2 (0.34)
Salem	2 (0.34)
Tahoe	2 (0.34)
Wave	2 (0.34)
LD Cigarettes	1 (0.17)

CC = combustible cigarettes; ENDS = electronic nicotine delivery systems; LCC = little cigars and cigarillos; SLT = smokeless tobacco.

Price Incentives

The overwhelming majority of ads (96.18%) across all product categories included price incentives of some kind. Coupons ranging from one or two dollars off a pack of CCs or SLTs to an ENDS starter kit for $1.99 were included in 73.83% of ads across products. Meanwhile 85.29% of ads included web promotions which referred recipients to rewards programs, discount codes, and in most cases, explicit instructions to visit the websites for special offers and promotions.

Inferring Appeal From Themes and Model Characteristics

More than a third of CC ads and nearly half of SLT ads used themes likely to appeal to rural white audiences. Although LCC and ENDS ads employed similar themes, they do so to a significantly lesser extent. Themes appealing to black audiences were relatively infrequent. However, black actors were most prevalent among CC and LCC ads compared to ads for other products. Similarly, ads likely to be appealing to black audiences were relatively less frequent than those appealing to white audiences. However, about one of every seven CC, LCC, and ENDS ads had at least one characteristic likely to appeal to a black audience. Finally, with regards to ads likely to appeal to youth, models under 35 were most prevalent in ENDS ads where they comprised half of all ads, and least prevalent in SLTs where they comprised about one in seven. Moreover, themes known to be appealing to youth were prevalent across products. Depictions of the social appeal of tobacco use was most prevalent across combustible products. In contrast, over half of ENDS ads featured tech/innovation themes. Using strict criteria of having both young models and containing at least one additional youth-appealing characteristic, 21.36% of CC ads, 7.65% of SLT ads, 27.27% of LCC ads, 45.10% of ENDS can be said to be overtly youth-appealing.

Distribution of Brands in Direct-Mail Ads

Table 3 provides a breakdown of brand prevalence by product. Brands owned by Altria (Phillip Morris) comprised 51.58% of all ads including 45.08% of CCs, 62.27% of SLTs, 63.64% of LCCs, and 47.06% of ENDS. Brands owned by RJ Reynolds comprised 31.81% of all ads including 36.44% of CCs, 24.01% of SLTs, 43.14% of ENDS, and 80.00% of ads advertising both combustible and noncombustible tobacco products. Swedish Match brands comprised 12.93% of SLT ads (4.97% of all ads) while Imperial Tobacco Group brands comprised 17.29% of CCs (9.93% of all ads).

Discussion

Our research found that almost all ads (96.18%) across all tobacco products offered price-reduction incentives in the form of physical coupons and/or referrals to brand websites for special offers and discounts. Moreover, we found a wide array of ad characteristics and themes likely to appeal to rural white, black, and young audiences. Particularly noteworthy was the prevalence of themes and ad characteristics likely to appeal to youth and young adults among ENDS ads. Brands owned by Altria and RJ Reynolds dominated direct-mail advertising, including over 90% of all ENDS mailed ads. Both companies are seeking authorization of ENDS products under the pretenses of harm-reduction,³⁶ with Altria actively running ads stating their commitment to reducing the burden of smoking.³⁷ However, these data demonstrate substantial investment by both companies in continuing to promote combustible tobacco by reducing cost barriers as well as presenting a demonstrably lethal product using themes and ad features that resonate with the lifestyles and aspirations of at-risk demographics.

Our findings highlight two important regulatory priorities. First, with coupons in nearly every mailer, the most obvious purpose of direct-mail advertising is to promote use through reducing cost barriers. These promotional efforts serve to essentially offset the impact of raising the cost of tobacco use through excise taxes—one of the most potent deterrents to initiation and progression of tobacco use, particularly among price-sensitive subgroups.^26,38,39 By discounting the cost of tobacco products by direct-mail, these offers can serve to reduce the motivation for current users to quit.⁴⁰ A review of tobacco industry documents between 1987 and 2016 showed a concerted effort by the industry to undermine excise taxes and minimum price restrictions through coupons and price incentives.⁴¹ This study shows that such strategies remain pervasive across multiple tobacco products. Thus, restrictions on the use of coupons and other discount promotions are needed to protect and amplify the proven effectiveness of excise taxes and other cost restrictions.

The second regulatory priority is to update advertising restrictions with more explicit guidelines, as the prevalence of youth-appealing content in direct-mail ads contradicts the tobacco industry’s mandate not to target youth. In this vein, preventing promotion of tobacco use to youth and young adults is complex, as ad features that appeal to young people are more complicated than cartoon Camels and ads on Saturday morning cartoons.¹⁶ Though we differentiate ad themes appealing to rural white, black, and young audiences, it is important to recognize that the sort of appeals to identity we highlight are likely appealing to youth who aspire to shared idealizations of rural, black, or other identities.⁴² Updated guidelines regarding what constitutes promoting addictive and lethal tobacco products to young people and non-smokers in-general are needed. Toward this end, this study provides an overview of some of the themes most commonly used across SLT, ENDS, LCCs, and CC products that should be considered in policy changes that protect vulnerable groups from tobacco marketing that happens out of public view. Furthermore, the tobacco industry’s continued willingness to circumvent advertising regulations intended to restrict problematic appeals provides further justification for a blanket ban on tobacco advertising and promotion, including through direct-mail.

Like previous research^11,12 we found consistent use of imagery romanticizing blue collar, rural, outdoor, patriotic, and traditional identities for SLT products. Harkening to early tobacco advertising mainstays like the Marlboro Man⁴³ such themes leverage this rural white ethos to promote harmful and addictive products to audiences that continue to have some of the highest tobacco-use rates⁴⁴ potentially reinforcing health disparities in preventable tobacco-related illnesses.⁴⁵ That such appeals are delivered alongside coupons and other price-incentives is particularly egregious.

Though CCs and SLTs comprise the majority of direct-mail ads, the same companies seeking authorization of ENDS products under the pretense of helping smokers quit simultaneously promote ENDS products through highlighting tech elements and promoting the innovativeness of their products, elements that can pique the curiosity of youth.¹⁶ Over three-quarters of ENDS ads and about half of all combustible product ads featured a combination of younger models and themes that are known to be appealing to youth, ranging from presenting tobacco products as important in socializing, high-tech, innovative, trendy, artistic, and a wealth of other appeals to desirable aspirational identities known to be salient among youth.³⁵ A noteworthy finding is that our sample included five ads promoting and providing coupons for both combustible and non-combustible products in the same mailer. Although ostensibly such coupons may be an effort at harm reduction, incentivizing consumers of combustible products to try alternative products, including coupons for both sets of products may just as easily incentivize dual-use and increased overall nicotine consumption rather than switching.

Black models and themes related to traditionally black contexts (eg, a multi-generational interaction in a barber shop) were featured in 15.59% of ENDS ads and 18.18% of CC ads. With the latest census suggesting black populations comprise 13.40% of the United States⁴⁶ and smoke at lower rates than other subgroups, including the majority white population,⁴⁷ direct-mail ads appear to be disproportionately targeted toward black audiences. These findings are consistent with previous research revealing deliberate efforts by the tobacco industry to target the black community.⁴⁸

In combination with previous research highlighting the effects of coupons and direct-mail advertising, this research highlights ad characteristics that may drive tobacco product initiation, continued use, and dual use across multiple tobacco products, which in turn may exacerbate both the existing burden of tobacco-related mortality and morbidity, particularly among vulnerable groups for whom tobacco-related health disparities already exist.

Limitations and Future Directions

Although this study has many strengths, it is not without limitations. First, our sampling strategy relies on a sample from the Mintel database’s census of ads. Although Mintel’s methodology assures an optimally representative sample of the ad content in circulation, our sample is ultimately a sub-sample of their sample. However, our human-coded content analysis of a random one in three direct-mail ads across all products over 3 years from a nationally recognized aggregator of marketing materials provides one of the most comprehensive overviews of the direct-mail advertising landscape to date.

Secondly, data on the demographics of panel members who received specific ads is limited, as supplying such information is optional. Quotas are used when recruiting panel members to assure the comprehensiveness of the gathered sample across demographics and geographic regions. Identifying information about which panel member scanned in which ad is generally not provided. Thus, while there is high confidence in the representativeness of the content gathered, there is limited ability to infer who received the content. The reach of direct-mail to diverse demographics has been established by previous research.^17,49 This study provides an accounting of the content.

Finally, the advertising characteristics we identify are not exhaustive, nor are the demographics they appeal to mutually exclusive. We do not capture every theme with potentially problematic appeal. Advertising trends shift with the market and the times. For example, we initially coded a category for women’s clothing and jewelry, as this theme was a mainstay of historic efforts by the tobacco industry to target women.⁵⁰ Such a theme showed up in 3.15% of ads, almost exclusively CCs. Moreover, 19.58% of ads had female models and 16.52% of ads had models whose race or ethnicity was neither black nor white, and otherwise unclear without relying on inconsistent and unreliable racial tropes. Our focus on rural white, black, and young audiences does not mean the tobacco industry does not target other audiences.

Our focus on a finite number of ad characteristics speaks to a fundamental limitation of this methodology in that it lacks the qualitative nuance that allows for more in-depth exploration of what characteristics are appealing to whom. This research is intended to supplement the sort of qualitative and experimental research that provides a holistic view of how the most common ad content affects groups of interest. For our part, this research uses stringent, triple-coded, content analysis of frequently occurring characteristics to provide conservative estimates of the prevalence of targeted advertising from which we can make strong inferences about the prevalence of such content throughout the broader population of direct-mail ads. While there is more research needed, we can say with strong confidence that direct-mail ads consistently use strategies that target young, black, and rural white demographics.

Conclusion

Themes used in direct-mail ads for today’s tobacco products harken back to pre-Master Settlement Agreement ads that used glamorous, sophisticated, or rugged archetypes of smokers to attract new users despite the addictive and carcinogenic effects of CCs. Moreover, ads for ENDS products use both young actors and themes highlighting innovation and technology to appeal to young people. The prevalence of price incentives delivered directly to consumers and out of the public eye threatens to undermine other measures designed to deter tobacco product use and incentivize quitting, particularly among youth and young adults who are price-sensitive. As current guidelines do not restrict such advertising practices, there is an urgent need for the US Food and Drug Administration to establish comprehensive guidelines for tobacco direct-mail advertising comparable to existing guidelines for other mediums.

Supplementary Material

A Contributorship Form detailing each author’s specific involvement with this content, as well as any supplementary data, are available online at https://academic.oup.com/ntr.

Funding

This work was supported by Truth Initiative.

Declaration of Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Acknowledgments

The authors would like to thank interns (Allison Buffet, Jordan Schneider, and Talene Appleton) who provided countless hours of support in developing our coding protocol, calibration, and coding ads during their tenure during the spring and fall semesters of 2019–2020; intern Bianca Tran for her statistical support; and Donna Vallone, PhD at Truth Initiative for oversight and editorial support. We also thank former Truth Initiative research staff, Lauren Czaplicki, PhD and Randall Simpson, MPH for their hard work on the initial phase of this research.

Data Sharing

A data sharing agreement is required for use of all data. Investigators seeking access to data used in the study should make a written request to Truth Initiative authors and submit a detailed research plan including the purpose of the proposed research, required variables, duration of the analysis phase, IRB approval with FWA information, and investigator training in human subjects. Approved investigators may access datasets via an analytic Portal owned and administered by Truth Initiative.

Disclaimer

This study is Truth Initiative’s analysis of Mintel Comperemedia Direct data and does not represent the views or the opinions of Mintel.