1. 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 Internet purchasing patterns among adult smokers in New Jersey

2. 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.

3. Cigarette Excise Taxes

4. 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)

5. 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.

6. 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

7. 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.

8. 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

9. 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.

10. 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

11. 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.

12. 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) Male54.0 ±2.152.8 ±2.6 White73.4 ±2.079.9 ±2.2 College degree or higher13.3 ±1.317.2 ±1.7 Cigarettes per day, mean (±SD) 15.1 (±0.25)14.4 (±0.28) 1 st cigarette <30 min after waking45.3 ±2.241.3 ±2.6 Quit attempt in past 12 mos54.2 ±2.156.0 ±2.6 *Unweighted n Data presented in percentages with 95% CI based on weighted estimates unless otherwise indicated.

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

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

15. Prevalence of ever purchased by smoking behavior, 2000-2002 NJATS Past year quit attempt CPD First cigarette

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

17. Prevalence of usually purchasing by smoking behavior, 2000-2002 NJATS Past year quit attempt CPD First cigarette

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

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

20. 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

21. 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

22. Ease of access to low cost cigarettes via Internet diminishes external motivations to quit. Websites selling cigarettes offer positive reinforcement for smoking. Implications

23. 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.

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