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Internet purchasing patterns among adult smokers in New Jersey. Mary Hrywna, MPH Cristine D. Delnevo, PhD, MPH Dorota Staniewska, MS. University of Medicine & Dentistry of New Jersey (UMDNJ) School of Public Health (SPH) 2003 National Conference on Tobacco or Health December 10, 2003.
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Internet purchasing patterns among adult smokers in New Jersey Mary Hrywna, MPH Cristine D. Delnevo, PhD, MPH Dorota Staniewska, MS University of Medicine & Dentistry of New Jersey (UMDNJ) School of Public Health (SPH) 2003 National Conference on Tobacco or Health December 10, 2003
Background • Currently estimated to be anywhere from 200 to 400 US and foreign-based websites selling cigarettes. • Cigarettes purchased via Internet are not exempt from state excise taxes but often promoted as tax-free.
Background • Existing literature on Internet cigarette purchasing addresses: • characteristics of Internet vendors (Ribsil, 2001) • vendor compliance with sales to minors (Bryant, 2002; Ribsil, 2002; Ribsil, 2003) • prevalence of Internet cigarette purchasing by youth (Unger, 2001; Abrams, 2003)
Background • Two previous studies have examined adult Internet cigarette purchasing: • Emery et al. (2002) found that 0.3% of smokers in California reported usually purchasing cigarettes over the Internet. • Hyland et al. (2002) reported that overall 1.4% usually purchased cigarettes via Internet but nearly 5% of smokers in four NY communities regularly purchased via Internet.
Background • Significant changes since these studies were conducted (1999 and 2001). • Tremendous growth in Internet cigarette vendors • Unprecedented number of states increased their cigarette excise tax
Study Objectives • To describe the prevalence of Internet cigarette purchasing among adult cigarette smokers in New Jersey in three repeated surveys. • To identify factors associated with ever and usually purchasing cigarettes via the Internet.
Data Source: NJATS • Data are from New Jersey Adult Tobacco Survey (NJATS), a point-in-time survey to monitor tobacco use behavior, knowledge, and attitudes. • Utilizes a RDD telephone survey designed to over-sample young adults, current smokers, recent quitters. • Sample size: • 2000, n=3605 • 2001, n=3930 • 2002, n=4004
Study Sample • In 2000 and 2001, participants were asked: • “Do you have access to the Internet at home, school, or work?” • In 2002, participants were asked: • “Have you ever used the Internet?” • Overall rates of Internet access were similar across years, 70.6%, 70.6%, and 69.5% (unweighted), respectively. • Total sample size = 2405 current cigarette smokers who had accessed the Internet.
Measures • Ever purchased was assessed by asking: • “Have you ever purchased tobacco products on the Internet?” • Usual purchase was assessed by asking: • “Do you usually buy your cigarettes in New Jersey, out of state, or over the Internet?” • Then examined by eight characteristics: • year of survey, age, race, gender, level of education, CPD, time to first cigarette, and past year quit attempt
Statistical Analysis • Sample weights applied to adjust for non-response and oversampling to provide results representative of New Jersey's adult population. • SUDAAN statistical software was used to generate adjusted odds ratio and 95% confidence intervals.
Current cigarette smokers vs. study population, 2000-2002 NJATS Data presented in percentages with 95% CI based on weighted estimates unless otherwise indicated. *Unweighted n
Prevalence of Internet cigarette purchasing by year, 2000-2002 NJATS
Prevalence of ever purchased by gender, race, and age, 2000-2002 NJATS
Prevalence of ever purchased by smoking behavior, 2000-2002 NJATS Past year quit attempt First cigarette CPD
Prevalence of usually purchasing by gender, race, and age, 2000-2002 NJATS
Prevalence of usually purchasing by smoking behavior, 2000-2002 NJATS CPD First cigarette Past year quit attempt
OR of ever purchasing tobacco via the Internet, 2000-2002 NJATS
OR of usually buying cigarettes via the Internet, 2000-2002 NJATS
Conclusions • Ever purchasing tobacco via the Internet increased by over 400% between 2000 and 2002. • Usually buying cigarettes via the Internet increased by over 200% between 2000 and 2002. • Heavy, more dependent smokers who were less interested in quitting more likely to report Internet cigarette purchasing.
Limitations • Rate of Internet cigarette purchasing may be higher in NJ relative to other states, given more widespread Internet access/consistently high state excise tax. • Data rely on self-report. • Survey question addressing Internet access was changed in 2002.
Implications • Ease of access to low cost cigarettes via Internet diminishes external motivations to quit. • Websites selling cigarettes offer positive reinforcement for smoking.
Implications • States losing millions annually in tax revenue from online cigarette sales. • In the past 5 years, New Jersey has collected <$700,000 in taxes based on reports from vendors. • Need better state and national surveillance of adult cigarette purchasing patterns.
Acknowledgements This work is partially supported by a contract from the New Jersey Department of Health & Senior Services