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

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.

Exploring the impact of genetic beliefs about specific eating behaviors on dietary self-efficacy.

Future personalized approaches to weight management are likely to include consideration of genetic influences on eating behaviors. This study explores whether genetic beliefs about eating behaviors influence dietary self-efficacy and confidence. In a survey of 261 individuals of various weight statuses, we find that endorsing genetic causes of two specific eating behaviors (taste preference and disinhibition) predicts poorer dietary self-efficacy for people who exhibit these eating behaviors. This suggests there may be utility to considering eating behaviors individually when it comes to predicting the influence of genetic information provision in the service of precision medicine interventions. Individuals with high disinhibited eating and/or bitter taster status may be particularly sensitive to interpreting genetic predisposition information in ways that undercut self-efficacy and confidence.

The relationship between food deserts, farmers' markets, Nutrition Benefits, and health in Delaware census tracts; 2017.

Food desert residents struggle to maintain a well-balanced, nutritious diet, increasing their risk of obesity and diabetes. Farmers' markets are a community-level intervention, bringing healthy food to food deserts. This study explores the relationship between food deserts, farmers' market location, the prevalence of obesity and diabetes, and the availability of Nutrition Benefit Programs (NBPs) in Delaware. Data are from the 2017 USDA Food Access Research Atlas and the Farmers' Market Directory. Descriptive statistics and spatial visualization were used to explore census tract-level relationships. Twenty percent of Delaware census tracts are food deserts. Of these, 7.2% have a farmers' market within their boundary, compared to 5.7% of non-food desert tracts. Of these markets, 3.2% accept Farmers' Market Nutrition Program coupons, 9.6% accept WIC Fruit and Vegetable Checks, and 21.6% accept Supplemental Nutrition Assistance Program. Sussex County has the highest obesity and diabetes rates, and the least number of markets that accept NBPs. Fresh food remains inaccessible to low-income residents, which is associated with diet-related chronic diseases. To reduce food insecurity, farmers' markets could expand acceptance of NBPs. Additional farmers' markets could be established in food deserts to increase the availability of healthy food, reducing the risk of developing obesity and diabetes.