Maximizing State and Local Policies to Restrict Tobacco Marketing at Point of Sale

Project Title: Maximizing State and Local Policies to Restrict Tobacco Marketing at Point of Sale

Organizations: University of North Carolina at Chapel Hill, Washington University in St. Louis, and Stanford Prevention Research Center

Grant Number: 1U01CA154281

Principal Investigators:
Kurt Ribisl, University of North Carolina at Chapel Hill
Doug Luke, Washington University in St. Louis
Lisa Henriksen, Stanford Prevention Research Center

Note: The descriptions in this section were provided by the principal investigator and are not maintained or updated by NCI.

Project Website:

Study Summary
Drs. Ribisl, Henriksen, and Luke conducted extensive surveillance of the retail environment for tobacco. Their research team evaluated the impact of state and community policies intended to counteract point-of-sale marketing and promotions as well as policies that restrict the number, type, and location of tobacco outlets. Using a variety of surveillance and ecological assessment methods, the team assessed local and state policy activities in the retail environment. Finally, they examined how the tobacco companies are responding with new marketing and promotional approaches.

Research Aims and Methods                                                                     

  • Examine changes in the amount and type of tobacco marketing materials and prices in a representative sample of U.S. tobacco retailers, by conducting store assessments nationwide.
  • Conduct implementation research that will guide states and communities seeking to more effectively regulate point-of-sale marketing.
  • Use retailer dataset to describe annual changes in the density and composition of tobacco outlets in a representative sample of U.S. counties.
  • Serve as a national resource for the dissemination of information on point-of-sale marketing and promotions and adoption of recommended policy changes.

Target Population: Tobacco retail environment

Key Findings

  • Audit-based measurement of retail tobacco marketing is increasingly used to monitor tobacco industry strategies and their influence on tobacco use by multiple population subgroups.
  • State-level retail tobacco policy activity increased dramatically from 2012 to 2015. Our systematic assessments show that the average amount of activity almost doubled during that time, increasing by 80%.
  • Adult smokers with serious mental illness lived in neighborhoods with two-fold greater tobacco retailer density than the average San Francisco Bay Area resident, and this neighborhood characteristic was associated with greater nicotine dependence and lower efficacy to quit smoking.
  • U.S. Census tracts with a greater proportion of households with same-sex couples also had comparatively higher tobacco retailer density.

Key Implications

  • Given a variety of unstandardized measures reported in the literature, Lee et al. make recommendations to improve the conduct and reporting of retail marketing audits.
  • Given what is known about the impact of the retail environment on tobacco use by youth and adults, state and local tobacco control programs may want diversify policy priorities by implementing retail policies alongside tax and smoke-free air laws.
  • Disparities in the spatial concentration of tobacco retailers may contribute to higher tobacco use among priority populations. Policy interventions to regulate the number, type, and location of tobacco retailers are recommended promote health equity.

Original Abstract
The point of sale (POS) is where tobacco companies spend the vast majority of their marketing budget and have enjoyed the greatest freedom from regulation. Regulatory efforts by states and communities have included licensing and zoning laws to limit the number, location and concentration (density) of tobacco retailers, and minimum price laws to reduce the supply of discount tobacco products. State and local agencies are also increasingly focused on eliminating racial and socioeconomic disparities in the amount of marketing and the density of tobacco retailers. Signed into law in June, 2009, the Family Smoking Prevention and Tobacco Control Act (FSPTCA) will change dramatically the tobacco retail environment because it grants states and communities new power to regulate the time, place, and manner of POS tobacco marketing. The broad goal of the proposed research is to establish timely and crucial national surveillance of how the U.S. Food and Drug Administration and states implement new regulations, the impact on the retail environment, and the response of tobacco companies. The specific aims are to examine changes in tobacco marketing and pack prices in a representative sample of U.S. retailers, conduct implementation research that will guide states and communities seeking to more effectively regulate POS tobacco marketing, measure annual change in the density and composition of tobacco retailers in a representative sample of U.S. counties, and disseminate information on POS marketing and tobacco retailer density nationwide. This will be accomplished using state-of-the-art surveillance and ecological assessment methods to select a longitudinal sample of 2,000 retailers and conduct in-store audits of tobacco marketing and price at three time points. POS policies and their implementation will be accessed via a national survey of tobacco control program leaders in every state, conducted at the same three time points. Six case studies and four legal research projects regarding POS restrictions will also be conducted. The established surveillance mechanism and the dissemination of study results will serve as important resources for national, state, and local efforts to reduce the public health toll attributable to tobacco use.