Tobacco Marketing at SNAP- and WIC-Authorized Retail Food Stores in the United States

Abstract

Background. Lower-income families in the United States are at increased risk for food insecurity and have higher rates of tobacco use. Many retailers accepting government food assistance benefits also sell tobacco products, whose marketing promotes smoking initiation and undermines quit attempts. We examined the presence of tobacco marketing in authorized retailers in the Supplemental Nutrition Assistance Program (SNAP) and/or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), compared with nonauthorized retailers. Method. A nationally representative sample of tobacco retailers in the contiguous United States ( N = 2,054) were audited for tobacco marketing in 2015. Using generalized estimating equations, we examined the association between WIC and SNAP authorization and presence of tobacco marketing, adjusted for store type and neighborhood demographics. Results. Both WIC-authorized (odds ratio [OR] 1.7, 95% confidence interval [CI] [1.1, 2.4]) and SNAP-authorized retailers (OR 2.3, 95% CI [1.7, 3.1]) had greater odds of displaying interior tobacco price promotions, compared with stores that were not WIC/SNAP authorized. SNAP-authorized stores (compared with nonauthorized) had almost 3 times greater odds of displaying interior tobacco advertisements (OR 2.9, 95% CI [1.9, 4.5]), while WIC-authorized retailers had 80% lower odds of displaying exterior tobacco advertisements (OR 0.2, 95% CI [0.1, 0.3]). Conclusion. Millions of lower-income American families may be disproportionately exposed to tobacco marketing at food retailers. Federal, state, and local policies could create healthier retail environments by restricting the marketing and availability of tobacco products and increasing promotions and access to healthy food options.

Smokeless Tobacco Point of Sale Advertising, Placement and Promotion: Associations With Store and Neighborhood Characteristics

“…Store type was highly associated with storefront ST advertising, similarly to the study by Widome and associates (25), with convenience stores being more than 16 times more likely to have exterior ST advertisements than mass merchandisers, drug, or grocery stores. Similarly to Roberts and associates' findings (24), our study found a small but significant association between ST advertising in urban or metropolitan vs. more rural areas, and reported evidence of differential tobacco marketing at the point-of-sale, which disproportionately targeted urban and African American communities (22). This is especially troublesome, given the large percentage of convenience stores available to youth in metropolitan areas.…”

“…Approximately one third of retailers (34%) were located in census tracts in which the population was in the top quartile for having a high school education or less, and more than one fifth (23%) were located in the top quartile for having children under the age of 18 years. Additionally, two thirds of retailers (67%) were located in census tracts in the highest quartile for living in poverty as defined by the US Census Bureau (22). More than one tenth were located in census tracts in the highest quartile for percentage of Black race (15%), more than one third were in census tracts in the highest quartile for the percentage of American Indian race (35%), and one fifth (22%) were in census tracts with the highest percentage of Hispanic or Latino ethnicity (Table 1).…”

“…Four trained project staff collected retailer data via the Store Audit Center, the online platform created by Counter Tools. The 16item STARS tool included questions about store type, exterior and interior advertising, type of tobacco products sold, and price, placement, and promotion of tobacco products (22).…”

“…The number and location of tobacco retail outlets in a community, specifically in proximity to schools, also increases the availability of tobacco products, the likelihood of tobacco experimentation among minors (19), and the sale of tobacco to minors (21). Studies have demonstrated a higher density of tobacco retailers in communities at greatest risk; those with low income, and with higher proportions of non-whites (18,19,(22)(23)(24)(25).…”

“…Additionally, retailers place tobacco products and advertising lower to the floor and within reach of products that appeal to youth (20), including soda and candy products, ICEE R drinks, jewelry, and electronic merchandise (20,24). Point-of-sale (POS) advertisements, which are advertisements displayed or distributed at retail locations, can introduce youth to tobacco products (18,22). Assessments of the tobacco retail environment are an essential component in building awareness and documenting tobacco industry activity in communities.…”