Most of the research on tobacco marketing at the point of sale describes patterns and trends in cigarette promotion.1–3 Among youth in the USA, however, use of other tobacco products, such as cigars/cigarillos, electronic cigarettes (e-cigarettes) and smokeless tobacco, exceeds rates of smoking.4 There is an urgent need to understand how diverse tobacco products are marketed in retailers that youth visit and how promotion differs by store type and neighbourhood demographics. We examined 1-year changes in the availability and advertising of non-cigarette tobacco products in a cohort of tobacco retailers near high schools in New Jersey, USA.
METHODS
In April 2015, research staff visited all tobacco retailers falling within a half-mile radius of the 41 high schools participating in the 2014 NJ Youth Tobacco Survey, a representative, probability sample of NJ youth5 (n=194 retailers). A half-mile is perceived by adolescents to be an easy walking distance and has been used in other studies assessing tobacco retailer density near schools.6 Data collectors documented product availability and presence of exterior and interior advertisements for cigarettes, cigars/cigarillos, e-cigarettes and smokeless tobacco.7 Stores were revisited in April 2016 using identical data collection methods. Details about the study’s methodology, including store sampling procedures, definitions of measures and other critical information, have been published elsewhere.7 Inter-rater reliability between data collectors was excellent in both years, with Cohen’s kappa statistics ranging from 0.8 to 1.0 for all categorical measures. Descriptive statistics highlighted prevalence differences between years, as well as by store type, student income level (percentage of students receiving free or reduced lunch) and percentage of non-white students. Eleven stores could not be reaudited in 2016 (eg, store not open, researchers asked to leave) but were retained in the analysis by assigning their 2015 values to produce the most conservative estimates. Given the study’s small sample size, statistical significance tests were not performed.
RESULTS
Aside from cigarettes, which remain the most common tobacco products promoted at the point of sale, cigars/cigarillos were the most accessible products near schools and were the only products to experience an increase in availability, exterior advertising and interior advertising from 2015 to 2016 (Table 1). Despite higher availability near low-income schools (91.2%) and schools with majority non-white students (91.4%), cigar/cigarillo advertising increased across all school districts. Notably, availability and advertising for e-cigarettes declined between years, decreasing across virtually all store types and school districts. Smokeless tobacco promotion remained relatively stable. The accessibility and promotion of e-cigarettes and smokeless tobacco were substantially more common in mid-to-high-income districts and near schools where a majority of students were white. Consistent with the literature on tobacco retailer density, lower-income schools had a higher average number of nearby retailers than mid-to-high-income schools (average: 20.4, range: 5–43 vs average: 4.4, range: 1–16, respectively).
Table 1.
Non-cigarette tobacco product availability and advertising in a cohort of retailers near New Jersey high schools, 2015–2016 (n=194)
| Cigarettes | Cigars/cigarillos | E-cigarettes | Smokeless tobacco | ||||||
|---|---|---|---|---|---|---|---|---|---|
| 2015 | 2016 | 2015 | 2016 | 2015 | 2016 | 2015 | 2016 | ||
| % | % | % | % | % | % | % | % | ||
| Product availability* | |||||||||
| Overall (n=194) | 99.0 | 99.0 | 82.0 | 87.1 | 57.7 | 46.9 | 20.1 | 16.5 | |
| Store type | |||||||||
| Convenience (chain) (n=11) | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 90.9 | |
| Convenience (non-chain) (n=88) | 98.9 | 98.9 | 87.5 | 92.1 | 45.5 | 33.0 | 9.1 | 9.1 | |
| Gas station (n=30) | 100.0 | 100.0 | 86.7 | 90.0 | 63.3 | 50.0 | 40.0 | 33.3 | |
| Drug store (n=18) | 100.0 | 100.0 | 61.1 | 61.1 | 88.9 | 77.8 | 33.3 | 11.1 | |
| Liquor store (n=25) | 100.0 | 100.0 | 84.0 | 96.0 | 56.0 | 44.0 | 8.0 | 4.0 | |
| Other† (n=22) | 95.5 | 95.5 | 59.1 | 68.2 | 54.6 | 50.0 | 0.0 | 4.6 | |
| School income level‡ | |||||||||
| Low income (n=102) | 98.0 | 98.0 | 82.4 | 91.2 | 44.1 | 33.3 | 8.8 | 5.9 | |
| Mid-to-high-income (n=92) | 100.0 | 100.0 | 81.5 | 82.6 | 72.8 | 62.0 | 32.6 | 28.3 | |
| Percent non-white students | |||||||||
| >90% (n=104) | 98.1 | 98.1 | 82.7 | 91.4 | 45.2 | 34.6 | 9.6 | 6.7 | |
| 50%–90% (n=45) | 100.0 | 100.0 | 77.8 | 80.0 | 62.2 | 48.9 | 13.3 | 6.7 | |
| <50% (n=45) | 100.0 | 100.0 | 84.4 | 84.4 | 82.2 | 73.3 | 51.1 | 48.9 | |
| Exterior advertising§ | |||||||||
| Overall (n=194) | 53.6 | 51.0 | 10.8 | 13.9 | 29.4 | 19.6 | 4.1 | 3.6 | |
| Store type | |||||||||
| Convenience (chain) (n=11) | 81.8 | 90.9 | 0.0 | 9.1 | 63.6 | 45.5 | 18.2 | 9.1 | |
| Convenience (non-chain) (n=88) | 58.0 | 56.8 | 13.6 | 17.1 | 27.3 | 18.2 | 0.0 | 1.1 | |
| Gas station (n=30) | 73.3 | 66.8 | 20.0 | 26.7 | 60.0 | 43.3 | 16.7 | 16.7 | |
| Drug store (n=18) | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | |
| Liquor store (n=25) | 32.0 | 32.0 | 8.0 | 8.0 | 12.0 | 4.0 | 0.0 | 0.0 | |
| Other (n=22) | 63.6 | 50.0 | 4.6 | 4.6 | 22.7 | 13.6 | 4.6 | 0.0 | |
| Student income level | |||||||||
| Low income (n=102) | 54.9 | 52.0 | 9.8 | 12.8 | 18.6 | 8.8 | 0.0 | 1.0 | |
| Mid-to-high-income (n=92) | 52.2 | 50.0 | 12.0 | 15.2 | 41.3 | 31.5 | 8.7 | 6.5 | |
| Percent non-white | |||||||||
| >90% (n=104) | 55.8 | 52.9 | 9.6 | 13.5 | 20.2 | 9.6 | 0.0 | 1.0 | |
| 50%–90% (n=45) | 51.1 | 48.9 | 11.1 | 11.1 | 28.9 | 13.3 | 2.2 | 0.0 | |
| <50% (n=45) | 51.1 | 48.9 | 13.3 | 17.8 | 51.1 | 48.9 | 15.6 | 13.3 | |
| Interior advertising | |||||||||
| Overall (n=194) | 64.4 | 63.9 | 15.0 | 22.7 | 32.0 | 25.3 | 10.8 | 11.9 | |
| Store type | |||||||||
| Convenience (chain) (n=11) | 90.9 | 90.9 | 54.6 | 63.6 | 90.9 | 90.9 | 72.7 | 81.8 | |
| Convenience (non-chain) (n=88) | 61.4 | 62.5 | 15.9 | 22.7 | 26.1 | 18.2 | 2.3 | 5.7 | |
| Gas station (n=30) | 56.7 | 53.3 | 16.7 | 30.0 | 43.3 | 40.0 | 33.3 | 30.0 | |
| Drug store (n=18) | 72.2 | 66.7 | 0.0 | 0.0 | 33.3 | 16.7 | 0.0 | 0.0 | |
| Liquor store (n=25) | 72.0 | 68.0 | 8.0 | 20.0 | 16.0 | 4.0 | 0.0 | 0.0 | |
| Other (n=22) | 59.1 | 63.6 | 9.1 | 13.6 | 27.3 | 31.8 | 4.6 | 0.0 | |
| School district | |||||||||
| Low income (n=102) | 58.8 | 56.9 | 8.8 | 17.7 | 20.6 | 16.7 | 2.9 | 3.9 | |
| Mid-to-high-income (n=92) | 70.7 | 71.7 | 21.7 | 28.3 | 44.6 | 34.8 | 19.6 | 20.7 | |
| Percent non-white | |||||||||
| >90% (n=104) | 59.6 | 57.7 | 10.6 | 18.3 | 22.1 | 18.3 | 3.9 | 4.8 | |
| 50%–90% (n=45) | 68.9 | 71.1 | 13.3 | 17.8 | 35.6 | 22.2 | 8.9 | 4.4 | |
| <50% (n=45) | 71.1 | 71.1 | 26.7 | 37.8 | 51.1 | 44.4 | 28.9 | 35.6 | |
Product availability was assessed by visual inspection, or if not seen, by asking the store employee if the product in question was sold there.
‘Other stores’ included tobacco stores, smoke shops, dollar stores, delis.
Low income defined as retailers near schools with >75% of students receiving free or reduced lunch.
An ‘advertisement’ was defined as an industry-made sign, larger than a standard index card, featuring a product logo and/or image
DISCUSSION
Although e-cigarette use among youth continues to receive considerable media attention, this study suggests that e-cigarette point-of-sale marketing at traditional tobacco retailers is slowing, mirroring the deceleration in youth e-cigarette use between 2015 and 2016.8 A greater concern may be the pervasiveness of cigars/cigarillos, more harmful combustible products whose health effects are well-documented.9 Cigarillos are particularly appealing to youth given their extremely low prices and extensive flavour options.10 11 Moreover, cigars/cigarillos are more likely to be available near low-income schools, whereas lower-risk, non-combustible products (ie, e-cigarettes, smokeless tobacco) are more commonly sold and promoted in mid-to-high-income school districts, a pattern that can potentially worsen existing disparities. Exposure to tobacco marketing has consistently been linked with youth smoking,2 3 and emerging evidence indicates that this relationship may be similar for non-cigarette tobacco products.7 While policy initiatives should restrict all tobacco advertising at the point of sale, curbing the promotion of the most dangerous combustible products that are popular among youth warrants prioritisation.
Acknowledgments
Funding This study was funded by a contract from the New Jersey Department of Health and Award Number DP5OD023064 from the Office of the Director, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the State of New Jersey or the National Institutes of Health.
Footnotes
Contributors DPG took primary responsibility for the study’s conceptualisation, data collection and analysis, and writing. CA participated in data collection, analysis and manuscript writing. MH and CDD contributed to the study’s conceptualisation and manuscript writing.
Competing interests None declared.
Ethics approval This study was approved by the Rutgers Biomedical Health Sciences IRB.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Unpublished data are available upon request.
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