1. The Importance of Point of sale
Counter Tobacco
Allison E. Myers, MPH
Kurt M. Ribisl, PhD
Adapted from a presentation given January 16, 2013
Office of Smoking and Health
Centers for Disease Control and Prevention
Atlanta, GA
Updated March 26, 2019

2. 3 Shelving Units: Marlboro. Camel. White Owl
One dozen signs: Winston. 72’s. Special Blend
One function item.
E-cigarettes: Krave
Flavored LCC
SNUS/Smokeless

5. $7.3 Billion Tobacco Industry Marketing Expenditures
Industry spends $1M/hour at retail
$7.3 Billion
Spent in 2017 on cigarette and smokeless tobacco marketing at the point of sale
Cigarettes
Smokeless Tobacco
Federal Trade Commission Cigarette and Smokeless Tobacco Reports
In fact they spend over $7 billion a year on this type of marketing-- equal to 89% of their TOTAL advertising and promotion budget and more than they spend in any other place. These numbers come from the Federal Trade Commission Reports which track expenditures by the big 6 tobacco companies.
Our forty years of tobacco control success has squeezed the tobacco industry into retail stores– due to the MSA and TCA the industry can no longer advertise on TV or billboards. The store is one are left largely open to the industry.
Obviously if the industry is spending that much money in one place, they think it is important and we do too.
Federal Trade Commission Smokeless Tobacco Report for Washington, D.C. 2019
Federal Trade Commission Cigarette Report for Washington, D.C. 2019

6. Industry is buying health behavior impact
Consider three customer segments:
NEVER-SMOKER
SMOKER
TRYING TO QUIT

7. Consider three customer segments:
NEVER-SMOKER

8. Kids are frequent c-store shoppers
nationally representative sample of year olds: Almost half (48%) visit at least once a week1
C-stores have more tobacco marketing materials than other store types2-5
Okay, I’ve already hinted that the tobacco industry is buying health behaviors and health outcomes – specifically, that they are purchasing youth initiation of tobacco products.
Let’s talk about how that happens. First, you need to know that young people are frequent convenience store shoppers. (Remember when I said that most cigarettes are purchased from c-stores? That’s important.) There have been several studies over time about the frequency of kid visits to c-stores and I want to share data from the newest one with the most rigorous methods. These data come from a nationally representative sample of 2, year olds, conducted in 2011 and About half – 48% of the kids surveyed -- stated they visited a convenience store at least one a week. What this tells us is that half of our children in the US, at least, are routinely exposed to product displays and advertising for tobacco as well as alcohol, sugar sweetened beverages and other unhealthy products.
Even worse, many studies have shown that c-stores have more tobacco marketing materials than other store types (e.g., a grocery store or pharmacy).
Sanders-Jackson, et al., 2015; 2. Feighery, et al., 2008; 3. Henriksen, et al., 2008; 4. Henriksen, et al., 2010;
5. SGR Report, 2012.

9. Exposure to in-store marketing linked to tobacco use initiation
Children and adolescents more frequently exposed to POS tobacco promotion have ~1.6 times higher odds of having tried smoking and
~1.3 times higher odds of being susceptible to future smoking compared to those less frequently exposed.
I imagine you guessed this, and it’s important to know we have the empirical evidence to confirm that your guesses are true.
Note we’ve measured initiation and smoking lots of different ways in this study – ever smoking, experimental smoking, initiation, becoming a daily smoker – all studies point to the same thing: the marketing and branding in the store environment WORKS to build a relationship with kids, and kids start smoking as a result of exposure to retail tobacco marketing.
Robertson, et. al. Point-of-sale tobacco promotion and youth smoking: a meta-analysis. Tobacco Control, 2016

10. Shopping, brand impressions prompt initiation
NEVER-SMOKER
Henriksen, et al., 2010, Pediatrics
GREATER VISIT FREQUENCY, GREATER BRAND IMPRESSIONS
= HIGHER ODDS OF INITIATION

11. From never-smoker to established-smoker
PUFFER
Greater ADVERTISING in stores
= 8% higher odds of becoming a puffer.
Slater, et al. (2007) Arch Pediatr Adolesc Med

12. From never-smoker to established-smoker
PUFFER
EXPERIMENTER
ESTABLISHED
Greater ADVERTISING in stores
= 8% higher odds of becoming a puffer.
Greater PROMOTIONS in stores increase odds of youth moving towards higher levels of uptake.
Slater, et al. (2007) Arch Pediatr Adolesc Med

13. Consider three customer segments:
SMOKER
TRYING TO QUIT

14. Cigarette display cues craving
SMOKER
Carter, et al., 2006, Nicotine & Tobacco Research
PICTURE OF EIGHT CIGARETTE PACKS INCREASED CRAVING AMONG NICOTINE-DEPRIVED AND NON-NICOTINE DEPRIVED SMOKERS

15. Cigarette displays prompt impulse purchase
SMOKER
TRYING TO QUIT
Wakefield, et al., 2008, Addiction
SMOKERS NOTICE THE DISPLAY. SOME GET THE URGE TO BUY.
SOME BUY, EVEN THOUGH TRYING TO QUIT

16. Close proximity associated with less long term quit success
Retailer density and proximity are important in helping understand the negative environmental and community impact of tobacco retailers.
We now have evidence that residential proximity to a tobacco retailer is correlated with a smokers’ ability to stay quit. On the slide here we see results from a study by Lorraine Reitzel and others from It shows us that if a recent quitter lives within 250 meters of a tobacco retailer, his or her odds of staying quit over 6 months are HALF that of someone who does NOT live within 250 meters of a retailer.
As a reference point, 250 m (or 820 feet) is just shy of 3 football fields.
Reitzel, et al., 2010, American Journal of Public Health

17. Retailer density near schools linked to prevalence
NO RETAILERS
(n=45)
LOW DENSITY
(1-5) (n=43)
HIGH DENSITY
(>5) (n=47)
11.9% prevalence
13.6% prevalence
15.1% prevalence
Henriksen, et al., 2008: Preventive Medicine
AREAS WITH HIGHER RETAILER DENSITY (>5) WITHIN WALKING DISTANCE HAD HIGHER OVERALL SMOKING PREVALENCE (15.1%)

18. Higher density associated with initiation among US young adults
2013 nationally representative sample of young adults aged 18-34, merged with 2012 US tobacco retailer list and home addresses
Higher retailer density associated with higher likelihood of initiating cigarette use among year olds (OR=3.75, 95% CI 1.18, 11.90)
Higher retailer density associated with higher likelihood of initiating non-cigarette combustible use among year olds (OR=3.16, 95% CI 1.03, 9.74)
Higher density is also associated with initiation among US young adults – both for cigarettes, but also for non-cigarette combustible products like little cigars and cigarillos.
In this study, the researchers compared where young adults lived with a tobacco retailer list on a national level, and found that where there was a higher density of tobacco retailers, young adults yr old age range were over 3 times as likely to initiative cigarette use, and young adults years old were over 3 times as like to initiate use with products like little cigars and cigarillos.
(Note: that there was a positive correlation between the younger age group and cigarettes, but not significant enough to claim)
Retail point of sale is designed to attract new tobacco users, discourage quitting, and create a normative environment [of acceptance and desirability].
Cantrell, et al., 2015.

19. Summary: $1M/hour well spent
New York Data – What’s In Store Campaign
Retail marketing:
Prompts initiation
Promotes daily consumption
Discourages quitting