Mary Hrywna, MPHCristine 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

Internet purchasing patterns among adult smokers in New Jersey

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.

Cigarette Excise Taxes

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

Current smokers

(n=3455)*

Current smokers who accessed the Internet (n=2405)*

Age, mean (±SD) 41.6 (±0.31) 38.2 (±0.33)

Male 54.0 ±2.1 52.8 ±2.6

White 73.4 ±2.0 79.9 ±2.2

College degree or higher 13.3 ±1.3 17.2 ±1.7

Cigarettes per day, mean (±SD)  15.1 (±0.25) 14.4 (±0.28)  

1st cigarette <30 min after waking 45.3 ±2.2 41.3 ±2.6

Quit attempt in past 12 mos 54.2 ±2.1 56.0 ±2.6

*Unweighted n

Data presented in percentages with 95% CI based on weighted estimates unless otherwise indicated.

Prevalence of Internet cigarette purchasing by year, 2000-2002 NJATS

4.52.7

1.7

10.0

1.7

3.6

0.81.1

0

5

10

15

20

2000 2001 2002 Overall

Per

cen

tag

eEver Purchased

Usually Purchase

Prevalence of ever purchased by gender, race, and age, 2000-2002 NJATS

4.3 4.7 4.9

1.8

3.64.1

3.1

7.26.4

0

2

4

6

8

10

Male Female White Black Hispanic 18-24 25-44 45-64 65+

Per

cen

tag

e

Prevalence of ever purchased by smoking behavior, 2000-2002 NJATS

3.34.5 4.7

14.4

6.2

3.4 3.3

6.0

0

5

10

15

20

<= 10 11 to 20 21 to 30 31+ <=30 min 30 min+ Yes No

Per

cen

tag

e

Past year quit attemptCPD First cigarette

Prevalence of usually purchasing by gender, race, and age, 2000-2002 NJATS

1.1

2.52.0

1.0 1.0 0.7 0.8

4.0

2.7

0

2

4

6

8

10

Male Female White Black Hispanic 18-24 25-44 45-64 65+

Pe

rce

nta

ge

Prevalence of usually purchasing by smoking behavior, 2000-2002 NJATS

1.31.8

3.03.4 3.1

0.8 1.1

2.5

0

2

4

6

8

10

<= 10 11 to 20 21 to 30 31+ <=30 min 30 min+ Yes No

Per

cen

tag

e

Past year quit attemptCPD First cigarette

OR of ever purchasing tobacco via the Internet, 2000-2002 NJATS

Adjusted odds ratio OR (95% CI) Cigarettes per day 10 or less 1.0 Referent 11 to 20 1.2 (0.6-2.4) 21 to 30 1.1 (0.4-3.5) 31 or more 3.9 (1.5-10.2) Past year quit attempt Yes 1.0 Referent No 1.8 (1.1-3.0) Year 2000 1.0 Referent 2001 1.6 (0.7-3.4) 2002 6.4 (3.0-13.4)

Adjusted for age, race, gender, education, first cigarette, and all other variables in table

OR of usually buying cigarettes via the Internet, 2000-2002 NJATS

Adjusted odds ratio OR (95% CI) Age 18-24 1.0 Referent 25-44 1.1 (0.3-4.3) 45-64 4.4 (1.1-17.1) 65+ 2.9 (0.4-19.3) First cigarette <30 min after waking 3.3 (1.2-9.2) 30 min or more after waking 1.0 Referent Year 2000 1.0 Referent 2001 0.6 (0.2-1.6) 2002 2.9 (1.1-7.7)

Adjusted for race, gender, education, CPD, past year quit attempt and all other variables in table

• 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.

Conclusions

• 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.

Limitations

• Ease of access to low cost cigarettes via Internet diminishes external motivations to quit.

• Websites selling cigarettes offer positive reinforcement for smoking.

Implications

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.

This work is partially supported by a contract from the New Jersey Department of Health & Senior Services

Acknowledgements