Tobacco Industry Marketing Exposure and Commercial Tobacco Product Use Disparities among American Indians and Alaska Natives

Dana Mowls Carroll, Claradina Soto, Lourdes Baezconde-Garbanati, Li Ling Huang, Brianna A. Lienemann, Helen I. Meissner, Shyanika W. Rose, Jennifer B. Unger, Tess Boley Cruz

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: Non-Hispanic American Indians and Alaska Natives (NH AI/AN) have the highest commercial tobacco use (CTU) among U.S. racial/ethnic groups. Tobacco marketing is a risk factor, however few studies examine it among NH AI/AN. Objective: We identified prevalence of tobacco industry marketing exposure and correlates of CTU among NH AI/AN compared to other racial/ethnic groups. Methods: Data were from wave 1 (2013–2014; N = 32,320) of the Population Assessment of Tobacco and Health Study, analyzing self-reported exposure to tobacco ads from stores, tobacco package displays, direct mail and email marketing. Correlates of CTU were identified and interactions between racial/ethnic groups and tobacco marketing were assessed. Results: NH AI/AN (n = 955) had a higher prevalence of exposure to retail tobacco ads (64.5% vs 59.3%; p < 0.05), mail (20.2% vs.14.3%; p < 0.001) and email (17.0% vs.10.6%; p < 0.001) marketing than NH Whites (n = 19,297). Adjusting for tobacco use and related risk factors, exposure to email marketing remained higher among NH AI/AN than NH Whites. Interactions between racial/ethnic groups and marketing exposures on CTU were nonsignificant. CTU was higher among NH AI/AN than NH Whites and among adults who reported exposure to tobacco ads, mail, and email marketing. Conclusions/importance: There is higher tobacco marketing exposure in stores and via mail for NH AI/AN. Email marketing exposure was higher, even after controlling for tobacco-related risk factors. The tobacco industry may be targeting NH AI/AN through emails, which include coupons and other marketing promotions. Culturally relevant strategies that counter-act tobacco industry direct marketing tactics are needed to reduce disparities in this population.

Original languageEnglish (US)
Pages (from-to)261-270
Number of pages10
JournalSubstance Use and Misuse
Issue number2
StatePublished - Jan 1 2020

Bibliographical note

Funding Information:
This study was completed as part of the collaborative research being conducted by the National Institutes of Health (NIH) and Food and Drug Administration (FDA) Tobacco Centers of Regulatory Science (TCORS) Vulnerable Populations Workgroup. This study was supported by the NIH, National Research Service Award T32 DA007097 from the National Institute on Drug Abuse for Carroll; grant number P50CA180905 and U54 CA180905 from the National Cancer Institute (NCI) and the Food and Drug Administration (FDA) Center for Tobacco Products (CTP) for Soto, Cruz, Unger, Lienneman and Baezconde-Garbanati; grant number T32CA009492-29 from NCI for Lienneman; grant number U54CA189222 under a subcontract to Westat from NCI, FDA and the Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science for Rose; and grant number P50 CA180907 from the NCI and FDA CTP for Huang. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.

Publisher Copyright:
© 2019, © 2019 Taylor & Francis Group, LLC.


  • American Indians/Alaska Natives
  • racial/ethnic disparities
  • smoking
  • tobacco marketing
  • tobacco use


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