Abstract
Background
Exposure to tobacco product marketing increases tobacco use among young adults, especially those from vulnerable communities (VCs).
Purpose
This study examined real-time tobacco marketing exposure among young adults from vulnerable and non-vulnerable communities using Ecological Momentary Assessment (EMA).
Methods
This study used EMA data to assess context (e.g., location and activity) of tobacco marketing exposure using four text-messaging surveys per day over 2 weeks. Young adult non-current tobacco users living in Washington, D.C. (n = 146; ages 18–24) recorded 5,285 surveys, including 20 participants (13.2%) from VCs with high proportions of lower income and racial/ethnic minorities, and high smoking rates. Unadjusted and adjusted multilevel logistic regressions were used to assess the associations between exposure to any and flavored tobacco marketing, VC residence, and real-time context.
Results
Fifty-nine participants (40.4%) reported at least one tobacco marketing exposure and recorded 94 exposure moments. In adjusted models, odds of exposure were higher among VC residents (AOR = 2.6, 95% CI = 1.2–5.4), in the presence of anyone using tobacco versus no use (AOR = 4.0, 95% CI = 2.4–6.7), at store/retail (AOR = 17.0, 95% CI = 6.4–44.8), or outside/in transit (AOR = 4.1, 95% CI = 2.1–7.8) versus at home. VC residence (AOR = 7.2, 95% CI = 2.3–22.2) was the strongest predictor of flavored tobacco marketing exposure among all covariates examined.
Conclusions
Young adults are predominantly exposed to tobacco marketing in their daily lives through retail advertisements. Young adults from VCs are at increased risks of seeing any tobacco and especially flavored tobacco marketing. Policies that curtail tobacco retailer density and advertisement displays may reduce overall and differential tobacco marketing exposure.
Real-time predictors of smoking among sexual minority and heterosexual young adults: An ecological momentary assessment study