Elsevier

Preventive Medicine

Volume 81, December 2015, Pages 232-235
Preventive Medicine

Brief Original Report
Point-of-sale tobacco marketing in rural and urban Ohio: Could the new landscape of Tobacco products widen inequalities?

https://doi.org/10.1016/j.ypmed.2015.08.024Get rights and content

Highlights

  • Analysis of external points-of-sale suggests differential tobacco marketing.

  • Ads for cigarillos and cigars were more prevalent in African American communities.

  • Promotions for e-cigarettes were more prevalent in African American communities.

  • Cigarillo advertising was more likely in disadvantaged and urban communities.

  • Urban, disadvantaged, African American communities advertised more product types.

Abstract

Considerable research has examined how cigarette point-of-sale advertising is closely related to smoking-related disparities across communities. Yet few studies have examined marketing of alternative tobacco products (e.g., e-cigarettes). The goal of the present study was to examine external point-of-sale marketing of various tobacco products and determine its association with community-level demographics (population density, economic-disadvantage, race/ethnicity) in urban and rural regions of Ohio. During the summer of 2014, fieldworkers collected comprehensive tobacco marketing data from 199 stores in Ohio (99 in Appalachia, 100 in Columbus), including information on external features. The address of each store was geocoded to its census tract, providing information about the community in which the store was located. Results indicated that promotions for e-cigarettes and advertising for menthol cigarettes, cigarillos, and cigars were more prevalent in communities with a higher percentage of African Americans. Cigarillos advertising was more likely in high-disadvantage and urban communities. A greater variety of products were also advertised outside retailers in urban, high-disadvantage, African American communities. Findings provide evidence of differential tobacco marketing at the external point-of-sale, which disproportionately targets urban, economically-disadvantaged, and African American communities. There is a need for tobacco control policies that will help improve equity and reduce health disparities.

Introduction

The burden of tobacco unduly affects certain populations, including people living in rural areas, people of low socioeconomic status (SES), and racial/ethnic minorities (Garrett et al., 2013, Wewers et al., 2006). Contributing to these differences, the tobacco industry has for many decades targeted its advertising at vulnerable populations (Yerger et al., 2007). For example, research has found more storefront advertising in low-income communities (Seidenberg et al., 2010), greater point-of-sale marketing for stores closer to, compared to farther from, schools (Pucci et al., 1998) and targeted advertising of menthol cigarettes to African American communities (Moreland-Russell et al., 2013).

With increased restrictions on the channels for advertising cigarettes, the tobacco industry has made advertising at the retail point-of-sale a primary focus (Pollay, 2007). Accordingly, the tobacco industry is directly involved in how its products are marketed at the point-of-sale, incentivizing retailers to post advertising and signage, provide product displays, and give price-related promotions (Lavack and Toth, 2006). Social ecological theory (McLeroy et al., 1988) suggests these point-of-sale advertisements can have powerful effects on intrapersonal and individual behavior. Research on cigarette smoking shows that exposure to point-of-sale tobacco marketing distorts adolescents' perceptions about the availability and popularity of tobacco (Henriksen et al., 2002) and increases their curiosity about its use (Portnoy et al., 2014). Moreover, exposure to point-of-sale tobacco marketing is associated with increasing the likelihood of smoking initiation (Henriksen et al., 2010) and impeding smoking cessation (Cantrell et al., 2015). When retailers use externally-visible advertising, individuals need not even enter the establishment to experience these exposures. Yet external advertising may also be more open to policy-based restrictions. In particular, local laws are typically upheld when they are “content-neutral” (restricting all outside advertising, rather than tobacco advertising alone). Such regulations can restrict the time, place, or manner of advertising—such as by prohibiting advertisements in residential areas, restricting their size, or delineating how far they must be from pedestrian areas.

Now, with the changing landscape of tobacco products, surveillance of the new point-of-sale environment is critical. Although research on point-of-sale marketing for cigarettes has increased, little research has examined alternative products like smokeless tobacco, cigars, cigarillos, or e-cigarettes (Lee et al., 2015). Understanding the current marketing strategies of the tobacco industry will help inform local, state, and FDA policy. Given the history of differential marketing of tobacco products to vulnerable populations, it is particularly important for public health research to monitor how advertising varies based on community demographics. Therefore, the purpose of the present study was to examine external point-of-sale marketing of various tobacco products and determine whether this marketing was associated with community-level demographic characteristics (population density, economic disadvantage, race/ethnicity) in urban and rural regions of Ohio.

Section snippets

Study setting and population

We obtained a list of all tobacco licenses issued within our seven Ohio counties of interest: Franklin County, which comprises the city of Columbus; and Brown, Guernsey, Lawrence, Muskingum, Scioto, and Washington Counties, which comprise areas of rural Appalachian Ohio. Columbus is a diverse city, with a population of approximately 822,000, of whom 59% are non-Hispanic White (U.S. Census Bureau, 2015). In contrast, the Appalachian region of Ohio is primarily rural, non-Hispanic White, and

Results

Of the retailers sampled, 37% were gas station convenience stores and 23% were stand-alone convenience stores; other retailers included mass merchandisers, grocery stores, drug stores, alcohol stores, tobacco shops, and bars/restaurants. The most prevalent external ads were for non-menthol cigarettes (60%), followed by menthol cigarettes (38%), e-cigarettes (35%), cigarillos/little cigars (28%), smokeless tobacco (30%), and cigars (4%). For external promotions (e.g., price reductions), 57% of

Discussion

This study is among the first to look at point-of-sale marketing of new products such as e-cigarettes. The present results provide evidence of differential tobacco marketing at the external point-of-sale, which disproportionately targets economically disadvantaged, African American communities in Columbus. Results also suggest that compared to rural Appalachia, urban Columbus is experiencing greater point-of-sale marketing for alternative tobacco products—particularly, e-cigarettes and

Conclusions

The present findings suggest the tobacco industry is engaging in differential marketing at the external point-of-sale, which disproportionately targets urban, high-disadvantage, and African American communities. Beyond mentholated cigarettes, this pattern extends to cigarillos, cigars, and e-cigarettes. Ultimately, there is a need for tobacco control policies that will help improve equity and reduce health disparities.

Conflict of interest statement

The authors declare that there are no conflicts of interest.

Funding

This work was supported by the National Cancer Institute under grant P50CA180908.

References (22)

  • D.B. Portnoy et al.

    Youth curiosity about cigarettes, smokeless tobacco, and cigars: prevalence and associations with advertising

    Am. J. Prev. Med.

    (2014)
  • L.G. Pucci et al.

    Outdoor tobacco advertising in six Boston neighborhoods: evaluating youth exposure

    Am. J. Prev. Med.

    (1998)
  • J. Cantrell et al.

    Marketing little cigars and cigarillos: advertising, price, and associations with neighborhood demographics

    AJPH

    (2013)
  • J. Cantrell et al.

    The impact of the tobacco retail outlet environment on adult cessation and differences by neighborhood poverty

    Addiction

    (2015)
  • CDC

    Little filtered cigar, cigarillo, and premium cigar smoking among adults — United States

    MMWR

    (2012–2013)
  • Bridgette E. Garrett

    Cigarette Smoking—United States, 2006–2008 and 2009–2010

  • L. Henriksen et al.

    Effects on youth of exposure to retail tobacco advertising1

    J. Appl. Psychol.

    (2002)
  • L. Henriksen et al.

    A longitudinal study of exposure to retail cigarette advertising and smoking initiation

    Pediatrics

    (2010)
  • L. Henriksen et al.

    Targeted advertising, promotion, and price for menthol cigarettes in California high school neighborhoods

    Nicotine Tob. Res.

    (2012)
  • A.M. Lavack et al.

    Tobacco point-of-purchase promotion: examining tobacco industry documents

    Tob. Control.

    (2006)
  • J.G. Lee et al.

    A systematic review of neighborhood disparities in point-of-sale tobacco marketing

    Am. J. Public Health

    (2015)
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