1. Wisconsin Public Health Association Annual Conference
Tobacco Point of Sale Advertising: Associations with Neighborhood Demographics in Madison, WI
Nina Gregerson MPH, CHES1, 2, Patrick Remington MD, MPH1, Ryan Sheahan BS2, Randy Glysch MS3, Jeffery S. Lafferty Ph.D.2, Justin Svingen MURP2
1UNIVERSITY OF WISCONSIN-MADISON: SCHOOL OF MEDICINE AND PUBLIC HEALTH (MADISON, WI); 2PUBLIC HEALTH MADISON & DANE COUNTY (MADISON, WI); 3WISCONSIN DEPARTMENT OF HEALTH SERVICE: DIVISION OF PUBLIC HEALTH (MADISON, WI).
Wisconsin Public Health Association Annual Conference
May 24, 2017

2. No financial relationships to disclose
Outline
Background
Importance
Methods
Results
Discussion
Next Steps
No financial relationships to disclose

3. Tobacco Point of Sale (POS)
Tobacco Point of Sale refers to the advertising, price promotion, and product placement within the retail environment (whether exterior or interior)1
Strongly influences tobacco use behaviors among youth and those trying to quit2

4. Examples

5. Examples

6. Background Early Tobacco Control Policies
Health Warning Labels
Prohibiting ads on TV/Radio
Minimum Purchase Age = 18
Clean indoor air laws
Master Settlement Agreement of 1998
Restrictions on certain advertising/marketing

7. Background: Wisconsin
General Smoking Rate = 17% 4
Disparities exist
African American Smoking Rate = 36% 4
Low Income Smoking Rate (<$24,000/year) = 26% 4
Tobacco-related costs = ~$4 billion every year
Tobacco industry advertising/marketing = ~$153 million 3

8. Importance First study of this kind in Madison, WI
Understand tobacco industry targeting
Understand inequalities in our community
Influence policy change

9. Methods: Data Collection
Cross-sectional retail assessment of tobacco retailers in Madison
Number of advertisements inside & out
≤ Average = 27
> Average = 46
Average = 7 ads per store

10. Methods: Data Collection
American Community Survey 5-year Estimates
73 Census Block Groups
African American Population
≤ Average = 53
> Average = 20
Average = 7.9%
Hispanic
≤ Average = 56
> Average = 17
Average = 8.1%

11. Methods: Data Collection
Populations of Color (African American + Hispanic)
≤ Average = 50
> Average = 23
Average = 14.3%
Low Income Population (household income below 150% FPL)
≤ Average = 42
> Average = 31
Average = 30.3%

12. Analysis Unconditional logistic regression analysis
Each variable is not mutually exclusive in each demographic and/or census block
Each demographic category was tested at the block group level for statistical association with above average tobacco advertisements

13. Results Above Average African American Population
Regression analysis (*=p value ≤ 0.05)

14. Results Above Average Hispanic Population
Regression analysis (*=p value ≤ 0.05)

15. Results
Above Average Populations of Color (African American + Hispanic)
Term
Odds Ratio
95%
C.I.
Coefficient
S. E.
Z-Statistic
P-Value
High Level Of Poverty (Yes/No)
3.2431
2.5614
0.7066
3.6251
0.0003*
High Tobacco Ad Average (Yes/No)
5.7669
1.4471
1.7521
0.7054
2.4839
0.0130*
CONSTANT *
0.6895
0.0000
Regression analysis (*=p value ≤ 0.05)

16. Results Above Average Tobacco Ad Exposure
Regression analysis (*=p value ≤ 0.05)

17. Discussion
African American & Low Income individuals targeted by the tobacco industry
Sponsor festivals
Advertise in specific publications/magazines
“We don’t smoke that sh*t. We just sell it. We reserve the right to smoke for the young, the poor, the black, and stupid.”-R.J. Reynolds Tobacco Company Executive

18. Discussion Policy Implications Feasible Local Policies w/ Preemption
Local v. higher government
Feasible Local Policies w/ Preemption
Neutral Sign Ordinances
Zoning Ordinances

19. Strengths
Can be replicated easily, at low costs, and in a relatively short amount of time
Utilize student interns/fellows
111 scans = ~2 weeks
Analysis = ~3 weeks
Reimbursement = mileage
Printing costs
Allows communities to assess the retail environment for future policy change
Allows communities to provide policy makers with data and pictures of what’s happening

20. Limitations Small Sample Size Number of Census block groups
A larger sample size (county level?) would provide a larger sample of Census block data to further explore associations

21. Next Steps Hopefully influence policy change!
Conducting another assessment of retail environment this summer
New form-Statewide
Looking at more than just number of advertisements
MENTHOL!
Price Promotions
Product Placement
Hopefully influence policy change!

22. Acknowledgements Fellow Authors
Ryan Sheahan
Patrick Remington
Randy Glysch
Jeff Lafferty
Justin Svingen
Abby Diehl, MPH (2015 AHEC intern-data collector)

23. References
1 Widome R, Brock B, Noble P, Forster JL. The relationship of neighborhood demographic characteristics to point-of-sale tobacco advertising and marketing. Ethn Health. 2013; 18(2): doi: /
2 Tobacco advertising, sponsorship, and promotion: Point of sale marketing. The Campaign for Tobacco-Free Kids. Published May Accessed July 28, 2016.
3 Campaign for Tobacco-Free Kids. Toll of tobacco: Wisconsin. Accessed July 26, 2016.
4 Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system [African American, Low Income, General Smoking], BRFS Module, accessed 7/25/2016.
5 Campaign for Tobacco-Free Kids. Tobacco company marketing to African Americans. Accessed May 17, 2017.