title: Exposure to tobacco coupons among U.S. middle and high school students.
abstract: BACKGROUND
  Tobacco marketing contributes to increased tobacco use susceptibility and sustained use. There are limited data on youth exposure to tobacco coupons, a type of pro-tobacco promotion.
  
  
  OBJECTIVE
  To explore channels through which youth report exposure to coupons and characteristics associated with this exposure. This may help inform efforts aimed at decreasing youth exposure to advertising and promotion.
  
  
  METHODS
  Data from the 2012 National Youth Tobacco Survey were analyzed in 2013 to estimate the self-reported prevalence of U.S. middle and high school student exposure to coupons through various channels. Associations among exposure to coupons and demographics, tobacco use, living with a tobacco user, and receptivity to tobacco marketing were examined using multivariate logistic regression models.
  
  
  RESULTS
  Approximately 13% of students reported exposure to tobacco coupons in the past 30 days through mail, digital communications, or tobacco packages. Prevalence was greatest among current tobacco users (34.0%) and those receptive to tobacco marketing (23.4%) compared to non-tobacco users (9.3%) and those not receptive to tobacco marketing (8.2%), respectively. Coupon exposure varied by sex, grade, and race/ethnicity. In adjusted models, current tobacco use (AOR=3.4, 95% CI=3.0, 3.9); living with a tobacco user (AOR=2.1, 95% CI=1.9, 2.4); and receptivity to tobacco marketing (AOR=2.3, 95% CI=2.0, 2.7) were independently associated with coupon exposure.
  
  
  CONCLUSIONS
  Findings from this study indicate that despite restrictions on marketing to youth, youth are still being exposed to tobacco promotions such as coupons. Efforts to limit youth exposure may be valuable in reducing curiosity, susceptibility, and initiation.
authors.affiliation: Office of Science, Center for Tobacco Products, Food and Drug Administration, Rockville, Maryland. Electronic address: greta.tessman@fda.hhs.gov.
authors.forename: Greta K
authors.initials: GK
authors.lastname: Tessman
authors.affiliation: Office on Smoking and Health, Epidemiology Branch, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
authors.forename: Ralph S
authors.initials: RS
authors.lastname: Caraballo
authors.affiliation: Office of Science, Center for Tobacco Products, Food and Drug Administration, Rockville, Maryland.
authors.forename: Catherine G
authors.initials: CG
authors.lastname: Corey
authors.affiliation: Office on Smoking and Health, Epidemiology Branch, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
authors.forename: Xin
authors.initials: X
authors.lastname: Xu
authors.affiliation: Office of Science, Center for Tobacco Products, Food and Drug Administration, Rockville, Maryland.
authors.forename: Cindy M
authors.initials: CM
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000329:Advertising / Q000191:economics / Q000379:methods; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D040541:Marketing / Q000191:economics / Q000379:methods*; D015995:Prevalence; D057566:Self Report; D012907:Smoking / Q000191:economics / Q000453:epidemiology*; D013334:Students / Q000706:statistics & numerical data; D019460:Tobacco Industry / Q000191:economics / Q000379:methods*; D062789:Tobacco Products / Q000191:economics*; D014481:United States / Q000453:epidemiology