Trends in point-of-sale tobacco marketing around college campuses: Opportunities for enhanced tobacco control efforts

Abstract

Objective

Colleges have implemented policies to limit tobacco use on-campus; however, the off-campus environment is often overlooked in tobacco control efforts. We assessed availability, marketing, and promotion of cigarettes, snus, and traditional smokeless tobacco (SLT) in a sample of communities surrounding 11 college campuses in North Carolina and Virginia.

Participants

Between January-March of 2011, 2012 and 2013, 481 tobacco-selling retailers, including convenience stores, pharmacies and supermarkets, located near campuses were assessed.

Methods

Trained observers completed annual point-of-sale assessments.

Results

The percentage of stores selling (81.4% to 58.6%; p<.0001) and advertising snus (80.1% to 53.11%; p<.0001) significantly decreased over time. Convenience stores increased promotions of cigarettes (65.4% to 72.8%; p=0.04) and SLT (3.1% to 23.3%; p=0.02).

Conclusions

Off-campus environments have abundant tobacco availability and marketing. Colleges should collaborate with state and local tobacco control advocates to address tobacco promotion near campuses to potentially decrease product appeal and access among young adults.

Introduction

Tobacco use is the leading cause of premature death in the United States ¹. Approximately 62% of young adults, ages 18–25, report ever use of a tobacco product ². Current cigarette smoking in this college-age population has declined from 24.4% in 2005 to 13% in 2015 ³. However, new products such as snus (a Swedish-type moist snuff that does not require spitting) and electronic nicotine delivery systems (ENDS, or e-cigarettes) have contributed to high rates of poly-tobacco use, with estimates of past 30-day use ranging from 15% to 30% ^4,5, making the young adult period a critical time for tobacco use interventions.

Tobacco use prevention efforts on college campuses have historically focused on changing individual behavior through cessation programs and education. However, environmental approaches aimed at creating a tobacco-free environment and restricting marketing have been increasingly promoted on college campuses. In 2012, the U.S. Department of Health and Human Services created the Tobacco-Free College Campus Initiative to promote the adoption and implementation of tobacco-free policies at colleges and universities ⁶. The number of campuses in the U.S. that have adopted tobacco policies has grown from 446 in 2010 to over 1,700 in 2016, with approximately 1,400 of those being 100% tobacco-free ^6,7. Smoke-free campus policies have been shown to reduce smoking prevalence, perceptions of peer tobacco use and smoking norms among college students ^8,9, while comprehensive tobacco-free campus policies are associated with fewer students reporting smoking or intention to smoke, as well as fewer reporting secondhand smoke exposure or seeing someone smoke on campus ¹⁰.

College policy efforts to date have focused on the college campus because that is the area under the immediate jurisdiction of campus policy makers. However, the environment just beyond campus, the off-campus environment, typically has abundant tobacco marketing where products are heavily marketed at the point-of-sale, making them highly visible, available, and affordable ^11,12. Point-of-sale marketing is important to monitor as it has been shown to be positively associated with a variety of smoking behaviors ¹³, including tobacco initiation among youth ^14,15, as well as cravings among current smokers ¹⁶, those trying to quit, and recent quitters ¹⁷. The point-of-sale environment around college campuses is often overlooked in tobacco prevention efforts, even though young adults are the youngest audience to which the industry can legally market.

A handful of studies have examined tobacco marketing by retailers around college campuses, finding it is an important factor for college students’ exposure to tobacco. For example, one study found that the point-of-sale is the single most common location where most college students are exposed to tobacco marketing ¹⁸ and new products, such as ENDS, have become increasingly available ¹⁹ and advertised in retailers located near college campuses ²⁰. In addition, specialty tobacco retailers, such as vape shops and hookah bars, are more likely to be located near colleges, especially large universities and private institutions ^21,22. However, only one paper to date, has assessed changes over time in tobacco retail marketing around college campuses, and focused on one product, e-cigarettes.²⁰ The focus of this paper is to assess changes over a two-year time-frame in the availability, advertising, and promotions of several tobacco products including cigarettes, traditional smokeless tobacco (SLT) (chewing tobacco, dip/moist snuff), and snus among retailers around college campuses.

We selected these products for several reasons. First, cigarettes and smokeless tobacco have historically been the most commonly used products, with marketing practices directed toward college youth and products widely available. We included snus due to tobacco companies’ increasing efforts to promote the product in the United States. While overall snus rates are low, there was a 98.7% increase in US sales between 2010 and 2015.²³ Finally, we did not include ENDS in this analysis as this data has been previously reported.²⁰

Methods

As part of the Smokeless Tobacco Use among College Students research study ^24,25, we assessed the tobacco retail environment of 11 southeastern 4-year college campuses annually between 2011 and 2013 for a total of three waves of data collection. Of the 11 participating colleges, seven were located in North Carolina (NC) and four were in Virginia (VA).

Sampling

Retailer sampling methods and procedures have been described in detail elsewhere ²⁰. Briefly, a repeated cross-sectional design was used to select and observe up to 15 tobacco retailers in each campus-community. A list of potential tobacco retailers was compiled annually using procedures adapted from the North Carolina Department of Public Safety to identify potential tobacco retailers for tobacco compliance checks, as well as online search queries of tobacco industry websites. Retailers were geocoded using GIS software ²⁶ and restricted to those within a 1-, 2- and 5-mile radius of each campus. Using this approach, our sample included 409 retailers in 2011, 417 in 2012, and 378 in 2013. A random sample of 15 retailers and 15 replacement retailers within a 1-mile radius of the campus was selected. If there were not enough retailers in the 1-mile radius, the sample was expanded to the 2-mile radius. If not enough retailers were in the 1 or 2-mile radius, the sample was expanded to the 5-mile radius. Each year, two schools required sample from the 5-mile radius (Table 1).

Table 1.

Store Distance from College

	2011 N (%)	2012 N (%)	2013 N (%)
Number of stores assessed	161	158	162
1 mile radius from campus	129 (80.1)	126 (79.8)	120 (74.1)
2 mile radius from campus	20 (12.4)	16 (10.1)	28 (17.3)
5 mile radius from campus	12 (7.5)	16 (10.1)	14 (8.6)

Procedures

Unannounced observations of tobacco retail outlets were completed by teams of two trained assessors using paper-pencil forms. Assessments were conducted annually in 2011, 2012, and 2013, between January and March, and took approximately 10–15 minutes per retail outlet to complete. If the retailer did not sell tobacco products, the store was considered ineligible and the assessment was terminated. Although retailer consent was not required, data collection was terminated if asked to do so by retail staff. The study protocol was deemed exempt from review by the Wake Forest School of Medicine Institutional Review Board.

Measures

Measures were adapted from previous tobacco retail assessments ^27–29. Assessors recorded store type (e.g. bar/restaurant, convenience store with and without gas, discount store, grocery store, liquor store, pharmacy, or tobacco shop); availability of each type of tobacco product (cigarette, SLT, and snus) (yes/no); counts of advertising inside the store (interior advertising) and outside the store on its premise (exterior advertising); and presence of product promotions, including buy-one-get-one free, multi-pack discounts, and gift with purchase (yes/no).

Data Analysis

Descriptive statistics were used to describe prevalence of product availability, interior and exterior advertising (coded as any vs. none), and promotion for each type of tobacco product. To compare the prevalence of each product by year in different store types–categorized as convenience (with gas), convenience (without gas), pharmacy, supermarket, and other (tobacco shop, bar, restaurant, liquor store, or discount store)–Pearson’s chi-square tests were performed. For small sample size comparisons, Fisher’s Exact Tests were applied. All statistical analyses were conducted using SAS 9.4 (Cary, NC).

Results

Across all three years, a total of 481 assessments were completed including 161 in 2011, 158 in 2012, and 162 in 2013. Completions ranged from 12 to 15 retailers per community each year due to ineligibility (i.e. retailer no longer in business or did not sell tobacco products) or retailers not being visited due to limited operating hours or incorrect address. Refusal rates were low (4.3% in 2011; 3.5% in 2012; 3.0% in 2013). Table 1 shows the distribution of stores within 1-, 2- and 5- mile radius by year.

Product Availability

All stores sold at least one tobacco product, as it was an eligibility requirement. Product availability is summarized in Table 2. Cigarettes were the most widely available product and were available in all retailers each year. Over 80% of stores sold SLT products each year, with convenience stores, supermarkets and other stores, including tobacco stores and large discount stores, most likely to sell. Pharmacies were the least likely to sell SLT products, ranging from a third to half of retailers offering the product each year. We did not find any statistically significant changes in stores with availability between 2011 to 2013 for SLT products for any store type. However, snus availability among all stores decreased slightly, from 81.4% of retailers in 2011, to 80.4% in 2012, followed by a substantial decrease to 58.6% in 2013 (p<0.001). Among specific store types, we found significant decreases in snus availability between 2011 and 2013 in convenience stores (with gas) (97.4% to 82.7% p=0.006), pharmacies (35.3% to 9.1%, p<0.001) and supermarkets (92.3% to 47.4%, p<0.001) (Table 2).

Table 2.

Availability and Promotions by Product Type, Year and Store Type

	Availability						Promotion
	2011 N (%)		2012 N (%)		2013 N (%)	p-value	2011 N (%)	2012 N (%)	2013 N (%)	p-value
Number of stores assessed	161		158		162		161	158	162
Any tobacco product
All stores	161 100%		158 100%		162 100%	-	112 69.6%	118 74.7%	113 69.8%	0.52
Convenience (with gas)	78 100%		73 100%		81 100%	-	60 76.9%	65 89.0%	65 80.3%	0.14
Convenience (without gas)	32 100%		35 100%		30 100%	-	20 62.5%	23 65.7%	15 50%	0.41
Pharmacy	17 100%		18 100%		22 100%	-	11 64.7%	8 44.4%	16 72.7%	0.18
Supermarket	26 100%		20 100%		19 100%	-	20 76.9%	16 80%	13 68.4%	0.76
Other (i.e., tobacco shop/bar/restaurant/liquor/discount)	8 100%		12 100%		10 100%	-	1 12.5%	6 50%	4 40%	0.28
Snus
All stores	131 81.4%			127 80.4%	95 58.6%	<.0001	22 13.7%	35 22.2%	26 16.1%	0.12
Convenience (with gas)	76 97.4%			66 90.4%	67 82.7%	0.006a	18 23.1%	26 35.6%	17 21%	0.09
Convenience (without gas)	20 62.5%			24 68.6%	16 53.3%	0.45	2 6.3%	8 22.9%	7 23.3%	0.10a
Pharmacy	6 35.3%			12 66.7%	2 9.1%	<.001a	0 0%	0 0%	0 0%	-
Supermarket	24 92.3%			20 100%	9 47.4%	<.001a	2 7.7%	1 5%	1 5.3%	1.00a
Other (i.e., tobacco shop/bar/restaurant/liquor/discount)	5 62.5%			5 41.7%	1 10%	0.07a	0 0%	0 0%	1 10%	0.60a
Traditional Smokeless Products
All stores		139 86.3%		135 85.4%	134 82.7%	0.64	42 26.1%	47 29.8%	51 31.5%	0.55
Convenience (with gas)		76 97.4%		71 97.3%	80 98.8%	0.74a	25 32.1%	29 39.7%	34 42%	0.41
Convenience (without gas)		22 69.8%		27 77.1%	24 80%	0.56	1 3.1%	9 25.7%	7 23.3%	0.02a
Pharmacy		9 52.9%		9 50%	7 31.8%	0.34	1 5.9%	1 5.6%	0 0%	0.52a
Supermarket		26 100%		20 100%	18 94.7%	0.29a	15 57.7%	6 30%	8 42.1%	0.17
Other (i.e., tobacco shop/bar/restaurant/liquor/discount)		6 75%		8 66.7%	5 50%	0.63a	0 0%	2 16.7%	2 20%	0.53a
Cigarettes
All stores		161 100%		158 100%	162 100%	-	95 59.0%	112 70.9%	102 63%	0.08
Convenience (with gas)		78 100%		73 100%	81 100%	-	51 65.4%	61 83.6%	59 72.8%	0.04
Convenience (without gas)		32 100%		35 100%	30 100%	-	17 53.1%	22 62.9%	14 46.7%	0.42
Pharmacy		17 100%		18 100%	22 100%	-	11 64.7%	8 44.4%	16 72.7%	0.18
Supermarket		26 100%		20 100%	19 100%	-	15 57.7%	16 80%	10 52.6%	0.16a
Other (i.e., tobacco shop/bar/restaurant/liquor/discount)		8 100%		12 100%	10 100%	-	1 12.5%	5 41.7%	3 30%	0.42 a

^aP-value from Fisher’s Exact test

Promotions

Product promotions, such as buy-one-get-one free, multi-pack discounts, and special prices for tobacco products were common each year, with 70–75% of retailers offering promotions each year (Table 2). Convenience stores (with gas) and supermarkets were the most likely to market promotions each year, with annual estimates ranging from 77–89% of convenience stores (with gas) and 68–80% of supermarkets. Promotions were most commonly found for cigarettes (60–71% of retailers). One-third to one-quarter of retailers promoted SLT (26–32%), and less than a quarter promoted snus (14–22%).

The number of stores with any promotions did not significantly change over the three years for any tobacco product. However, when examining product-specific promotions by store type, we found significant increases among convenience stores (without gas) in the number of promotions for SLT products (3.1% in 2011 to 23.3% in 2013, p=0.02) and convenience stores with gas for cigarettes (65.4% in 2011 to 72.8% in 2013, p=0.04).

Interior Tobacco Advertising

Most stores (94–96%) displayed at least one interior tobacco product ad each year. All pharmacies and supermarkets had interior tobacco advertising. Most convenience stores with gas (99–100%) and without gas (86–88%) displayed interior advertising. There were no statistically significant changes in the number of stores with interior advertising for SLT or cigarettes over the three years. However, the number of stores that had interior advertising for snus significantly decreased from 2011 to 2013 (80.1% in 2011, 70.9% in 2012, 53.1% in 2013; p<0.0001). All store types, except convenience stores without gas, had a significant reduction in interior advertising for snus (Table 3).

Table 3.

Interior and Exterior Advertising by Product Type, Year and Store Type

	Interior Advertising				Exterior Advertising
	2011 N (%)	2012 N (%)	2013 N (%)	p-value	2011 N (%)	2012 N (%)	2013 N (%)	p-value
Number of stores assessed	161	158	162		161	158	162
Any tobacco product
All stores	155 96.3%	149 94.3%	153 94.4%	0.66	104 64.6%	100 63.3%	98 60.5%		0.73
Convenience (with gas)	78 100%	73 100%	80 98.8%	1.0	72 92.3%	67 91.8%	69 85.2%		0.26
Convenience (without gas)	28 87.5%	30 85.7%	26 86.7%	1.0	24 75%	24 68.6%	24 80%		0.57
Pharmacy	17 100%	18 100%	22 100%	-	0 0%	1 5.6%	0 0%		0.61
Supermarket	26 100%	20 100%	19 100%	-	7 26.9%	2 10%	2 10.5%		0.34
Other (i.e., tobacco shop/bar/restaurant/liquor/discount)	6 75%	8 66.7%	6 60%	0.89	1 12.5%	6 50%	3 30%		0.21
Snus
All stores	129 80.1%	112 70.9%	86 53.1%	<.0001	7 4.4%	5 3.2%	4 2.5%	0.63a
Convenience (with gas)	74 94.9%	61 83.6%	64 79%	0.009a	6 7.7%	2 2.7%	3 3.7%	0.34a
Convenience (without gas)	19 59.4%	21 60%	16 53.3%	0.84	1 3.1%	2 5.7%	1 3.3%	1.00a
Pharmacy	6 35.3%	10 55.6%	1 4.6%	<.001a	0 0%	0 0%	0 0%	-
Supermarket	25 96.2%	16 80%	5 26.3%	<.001a	0 0%	0 0%	0 0%	-
Other (i.e., tobacco shop/bar/restaurant/liquor/discount)	5 62.5%	4 33.3%	0 0%	0.01a	0 0%	1 8.3%	0 0%	1.00a
Traditional Smokeless Products
All stores	135 83.9%	129 81.7%	123 75.9%	0.18	29 18%	37 23.4%	40 24.7%	0.31
Convenience (with gas)	75 96.2%	68 93.2%	77 95.1%	0.71a	21 26.9%	28 38.4%	35 43.2%	0.09
Convenience (without gas)	23 71.9%	25 71.4%	20 66.7%	0.88	5 15.6%	6 17.1%	4 13.3%	0.94a
Pharmacy	6 35.3%	8 44.4%	3 13.6%	0.08a	0 0%	0 0%	0 0%	-
Supermarket	26 100%	20 100%	18 94.7%	0.29a	2 7.7%	0 0%	0 0%	0.33a
Other (i.e., tobacco shop/bar/restaurant/liquor/discount)	5 62.5%	8 66.7%	5 50%	0.81a	1 12.5%	3 25%	1 10%	0.70a
Cigarettes
All stores	154 95.7%	148 93.7%	153 94.4%	0.73	100 62.1%	95 60.1%	96 59.3%	0.87
Convenience (with gas)	77 98.7%	73 100%	80 98.8%	1.0b	71 91.0%	63 86.3%	67 82.7%	0.30
Convenience (without gas)	28 87.5%	30 85.7%	26 86.7%	1.0b	22 68.8%	23 65.7%	24 80%	0.42
Pharmacy	17 100%	18 100%	22 100%	-	0 0%	1 5.6%	0 0%	0.61a
Supermarket	26 100%	19 95%	19 100%	0.60 a	6 23.1%	2 10%	2 10.5%	0.51a
Other (i.e., tobacco shop/bar/restaurant/liquor/discount)	6 75%	8 66.7%	6 60%	0.89a	1 12.5%	6 50%	3 30%	0.21a

^aP-value from Fisher’s Exact test

Exterior Tobacco Advertising

Exterior advertising was less common than interior advertising for all types of tobacco products assessed. Just under two-thirds (61–65%) of retailers displayed exterior tobacco advertisements (Table 3). There were no significant changes in exterior advertising for any product during the study. Exterior ads were most common at convenience stores with gas (85–92% of retailers) and convenience stores without gas (69–80% of retailers) (Table 3). Store types that were less likely to display exterior tobacco advertising included pharmacies (0–5.6%), supermarkets (10–27%) and stores in the “Other” category (13–50%). Exterior ads were most common for cigarettes, with approximately 60% of stores displaying this advertising. Exterior advertising was less common for SLT products, ranging from 18–25% of stores displaying at least one exterior ad, and even less so for snus, with only 3–4% of stores displaying an exterior ad.

Comment

The results of this study show a tobacco-friendly retail environment close to college campuses in two tobacco-growing states, where tobacco products were readily available, widely promoted, and advertised by a variety of tobacco retailers. Cigarettes were the most widely available and advertised of all assessed products. They were sold in every store visited each year, reflecting the smoking patterns among the college-aged population, which ranges from heavy smokers to social smokers.³⁰ There is a high potential of occasional smokers to advance to more frequent smoking³¹ and most smokers start the habit before the age of 21.² Therefore, retailers around college campuses are prime locations for cigarette promotion to reach the young adult population,³² and thus for tobacco prevention efforts, to limit availability. One such strategy, recommended by The Institute of Medicine (IOM), is to restrict the number and location of tobacco retailers in a given area.³³ Strategies to control land use, such as outlet licensing and zoning ordinances, can be valuable tools in reducing the amount of tobacco advertising in communities.³⁴ While tobacco outlet density has historically focused on proximity to schools, policies should be expanded to include the broader community to limit density around neighborhoods where vulnerable populations, including youth and young adults, live.^35–37 Colleges should consider working with localities to regulate tobacco outlets around their campus, as these efforts can reduce the exposure to branded tobacco advertisements, product demand and tobacco use.^38,13

Although not as widely available as cigarettes, SLT was available in over 80% of stores each year and heavily advertised in convenience stores and supermarkets. The sustained availability of SLT products may be reflective of trends of increasing use during those years, as unit sales nationwide increased 57% between 2005 and 2011.³⁹ SLT marketing in retailers around college campuses may be aimed at smokers to bypass on-campus smoke-free policies, as advertising for SLT has focused on being acceptable alternatives to cigarettes when smoking is not allowed.⁴⁰ Importantly, use of SLT by college students who smoke may contribute to the persistence of their smoking behavior.²⁵ To counter this, colleges and universities should consider passing tobacco-free policies or amending current tobacco policies to the more comprehensive policies, which would prevent use of smokeless tobacco, as well as other tobacco products, on campus.

We found a significant decrease in the availability and advertising for snus, reflecting declines in use among college students and young adults.⁴¹ Snus first became available nationwide in the US in 2010 after being test marketed in several cities between 2006–2007. This low-nitrosamine, smokeless tobacco product has been reported to be 90% less harmful than smoking cigarettes⁴² and has been discussed as a potential strategy to reduce tobacco harm.^43,44 However, although most adult smokers were aware of it, as of 2012 only 20% tried it, and very few migrated to regular use because of dissatisfaction with mouth feel and preference for other forms of tobacco.⁴⁵ In addition, newer tobacco products, such as electronic cigarettes, which made smoking cessation and reduced harm claims⁴⁶ also became widely available in the mainstream market during this time,²⁰ which may have impacted consumer interest in snus. As a result, tobacco companies may be diverting some of the advertising and promotional resources from snus to their respective e-cigarette brands to support growth of product lines that have a potentially larger market, especially among the young adult population that may be more willing to try new tobacco products because of attractive packaging and flavorings.⁴⁷

However, it is important to continue monitoring snus, as there is evidence that this product is not going away. Snus shops, similar to vape shops or hookah stores, in which snus is sold alongside free coffee and wifi, are becoming more prevalent throughout the United States, indicating tobacco companies’ dedication to the product⁴⁸ and new opportunities for the population to be exposed to tobacco. Also, Swedish Match previously submitted Modified Risk Tobacco Product (MRTP) applications to the Food and Drug Administration (FDA) which would allow Swedish Match to make claims that their snus product is less harmful than cigarettes. While denied initially, if passed during future attempts, this could change the tobacco landscape.⁴⁹

Stores offering product promotions, such as special prices and buy-one get-one free, significantly increased for two of the products, cigarettes and SLT, but only at convenience stores. College students have been identified as a growing base for convenience stores, where they spent $5.2 billion between 2011 and 2012, and over 30% of their purchases were impulse buys.³² Tobacco advertising is abundant at the point-of-sale in convenience stores and has been shown to encourage impulse buys among those trying to quit.²⁷ The increase in product promotions reflects a continued concentration of tobacco expenditures at the point-of-sale by tobacco companies for cigarettes and SLT.^11,12 While these promotions are discounts paid directly to retailers or wholesalers, their intent is to reduce product price for consumers, and thus encourage use. Multiple studies have shown that changes in price of cigarettes leads to changes in use, especially for younger populations.^50–52 Although we only found a statistically significant increase in smokeless tobacco and cigarette promotions among convenience stores, the products were promoted in other store types. Approximately one-third to half of all supermarkets advertised a SLT product promotion, while almost one-half to three-quarters of pharmacies and supermarkets offered them for cigarettes. Our findings suggest promotions are prevalent at various types of tobacco retailers around college campuses and efforts to limit practices of tobacco retailers around the campus should be considered.

Because we found that specific store types, including convenience stores, pharmacies and supermarkets, heavily marketed cigarettes and smokeless tobacco, college campuses and local prevention advocates should also explore strategies to limit tobacco marketing in specific store types. One such strategy that local communities have implemented⁵³ is prohibiting tobacco sales in pharmacies. These retailers are the focus of such regulation because they are licensed by states to provide health advice and services, yet advertise and promote harmful tobacco products. In 2014, CVS Health became the first national retail pharmacy to ban tobacco sales at all of their stores.⁵⁴ This strategy not only reduces the number of tobacco retailers in a given area, but also can reduce tobacco exposure to vulnerable populations such as those trying to quit and recent quitters.⁵⁵ In our study, pharmacies sold, promoted and advertised SLT products and snus less than convenience stores or supermarkets. However, advertisements, promotions and availability of cigarettes among pharmacies were equivalent to that of the convenience stores and supermarkets. Colleges should consider working with localities to advocate for tobacco-free pharmacies around their campuses as part of their school’s comprehensive tobacco control strategy.

With the passage of the Family Smoking Prevention and Tobacco Control Act in 2009, and the final deeming regulation in 2016, new opportunities for collaborations between colleges and local governments have emerged, as tobacco control policies aimed at the point-of-sale can now be enacted by local and state governments. With this expanded authority, localities can explore legislation that bans or restricts the time, place, and manner of advertising or promotion at the point-of-sale such as requiring that tobacco products be placed behind the counter or out of customers’ sight, and/or creating tobacco-free zones within 1,000 feet of schools⁵⁶ to protect students from tobacco advertising exposure.⁵⁷ Colleges and community advocates can collaborate to implement these strategies and can draw upon the growing literature documenting the successful examples of controlling tobacco and alcohol availability and marketing around college campuses using coalitions as a vehicle.^57–61 Future studies should explore how the collaborations implement these regulatory efforts in off-campus communities to expand the reach of college tobacco prevention and control efforts.

Finally, colleges should reassess their own tobacco policy, as smoke-free and tobacco-free policies can shape student perceptions and impact tobacco use.^8,9 None of the participating colleges in this study had a comprehensive tobacco-free policy; however, each had policies that restricted on campus smoking, such as smoke-free dorms and smoking restrictions near building entrances. In contrast, comprehensive policies restrict tobacco-related advertising or sponsorship and prohibit tobacco-industry funding, which reduces tobacco product promotion.⁶¹ More research is needed to determine if these less restrictive campus policies, coupled with retailer interventions, can impact student behavior. Future studies should also explore if the retail environment differs around colleges with smoke-free or tobacco-free policies compared to policies that only restrict use on various parts of the campus.

Limitations

As with all research, our study has some limitations. First, this study was conducted in two tobacco-producing, southeastern U.S. states, which may limit its generalizability to other states. Second, even though we adapted methods used by the North Carolina Alcohol and Beverage Control (ABC) Commission to identify potential tobacco retailers, our strategy may have inadvertently missed some retailers that sell tobacco products. Third, we did not assess cigars, cigarillos or electronic cigarettes each year, and thus did not include them in this analysis. Finally, we were unable to test community differences due to a limited number of communities and because each community included a relatively small sample of retailers. Despite these limitations, this is the first study that assesses the marketing of multiple tobacco product types at the point-of-sale around college campuses, over time.

Conclusions

This study highlights changes to the evolving retail tobacco environment around college campuses. It underscores the importance of future monitoring to determine if and how the marketing of tobacco products around college campuses is different from non-college environments and document differences in how products are marketed in various types of retail outlets. It also emphasizes the need for college administrators to consider the larger community environment when planning tobacco prevention efforts aimed at their students and staff. Colleges should work with local and state governments as well as community coalitions to enact appropriate policies and strategies aimed at making their communities less tobacco-friendly.